经皮主动脉瓣植入TAVIppt课件.ppt

《经皮主动脉瓣植入TAVIppt课件.ppt》由会员分享，可在线阅读，更多相关《经皮主动脉瓣植入TAVIppt课件.ppt（41页珍藏版）》请在淘文阁 - 分享文档赚钱的网站上搜索。

1、文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。QUIZStreetAvenue文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Street文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Avenue文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Hospital of UA文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Hospital of UA文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Hospital o

2、f UA文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Hospital of UA文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Summarize of TAVITranscatheteraorticvalveimplantation(TAVI)Itwasintroducedasanalternativetreatmentinpatientswithsevereaorticvalvestenosis(AS)Cribier A,Eltchaninoff H,Bash A,Circulation 2002;106:30063008.文

3、档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。First Case of TAVIIn2002,CribieretaldemonstratedforthefirsttimethefeasibilityofapercutaneousvalveimplantationinapatientwithASProvidingapromisinglessinvasivealternativetreatmentforvalvularheartdiseaseCribier A,Eltchaninoff H,Bash A,Circulation 2002;106:30063008.文

4、档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。twodifferentTAVIdevicesarewidelyusedtheballoon-expandableEdwardsSAPIENTranscatheterHeartValvetheself-expandingMedtronicCoreValveBothreceivedCEMarkapprovalforEuropeancommercialsalein2007EdwardsSAPIENvalvereceivedFDApre-marketapprovalintheUSAinNovember2011Two diff

5、erent TAVI devices文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Edwards balloonexpandable delivery systems文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。CoreValve ReValving System(a)schemata and(b)following deployment with aortography文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Patients SelectionFeasibleinmostpatientswi

6、thsevereaorticstenosisGenerallyutilizedinpatientsnotsuitableforsurgicalAVR,whoarelikelytoderivefunctionalandsurvivalbenefitTworiskscoresareusedtocalculatetheriskofcardiacsurgery文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。“High-risk”surgicalpatientsHavingaSocietyofThoracicSurgeonsPredictedRiskofMortality(

7、STS-PROM)at30daysofgreaterthan10%LogisticEuroSCOREofgreaterthan20%LimitedDonotaccountforseveralpertinentclinicalriskfactors,suchaspreviousCABG,porcelainaorta,previouschestradiotherapy,severelungdisease,andlivercirrhosisTwo risk scores文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Tworiskscores文档仅供参考，不能作为科学依

8、据，请勿模仿；如有不当之处，请联系网站或本人删除。Assessments of TAVIToassesstheaorticannulusdimensionsandgeometry,accesssite,andapproachTransthoracicechocardiographyCoronaryangiographyAorticangiographyMDCT文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Assessment of arterial accessTheevaluationisfundamentalintheassessmentoftheTAVIp

9、atientinminimizingpotentialmajorvascularcomplicationsArterialdimensionsThepresenceorabsenceofatheroma,CalcificationTortuosity文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Assessment of arterial accessArterialaccessisassessedwiththecombinationofinvasiveangiographyandcontrast-enhancedCTIliofemoralassessmentw

10、ith(a)angiographyand(b)MDCT文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Assessment of aortic rootUsinginvasiveangiographyandcontrastMDCTevaluaterootandvalvularcalcificationleftmainheightfromtheleftcoronarycuspinsertion(duetoriskofcoronaryobstruction)technicalissuesrelatedtoeachvalvetypeanddeliverysystemEu

11、ropean Heart Journal(2014)35,26272638文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Assessmentofaorticroot(1)aortic annulus diameter,(2)sinus of Valsalva width(3)ascending aorta width,(4)sinus of Valsalva height文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Assessment of aortic root文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站

12、或本人删除。AssessmentsLeftandrightheartcatheterizationsarealsoperformedassessthepresenceofpulmonaryhypertensioncoronaryischemiaandtheneedforrevascularizationpriortoTAVI文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Requirements of TAVITAVIshouldbeperformedinregionalcentersofexcellencewithadedicatedheartvalveprog

13、ramandhighproceduralvolumesTheproceduremaybeundertakeninacardiaccatheterizationlaboratorywithmodificationsorinahybridoperatingroomequippedwithhigh-qualityfluoroscopicimaging文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Requirements of TAVIThefacilitiesneedtobelargeenoughtoaccommodatesophisticatedX-rayimagi

14、ngintegratedwithechocardiography,cardiopulmonarybypassandintra-aorticballoonpumpmachines,andanesthesiaequipment,withsurgicalsterilitystandardsmandatory文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Techniques of TAVITAVIismostoftenperformedutilizingthetransfemoralretrogradeapproachAlternativeaccessapproache

15、susuallyreservedforpatientswithconcomitantsevereperipheralarterialdisease文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Transfemoral ApproachThecommonfemoralartery,atthelevelofthefemoralhead,istheprimaryaccesssiteforthetransfemoralapproachowingtoitsrelativelylargesizeandcompressibilityThesidewiththelargesta

16、ndleastdiseased,tortuous,orcalcifiediliofemoralarteryasassessedbyascreeningangiogramand/ormultidetectorcomputedtomographic(CT)angiographyisselectedforplacementofthesheath文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Transfemoral ApproachThepotentialsiteofaccessisassessedfirstwithfluoroscopyand/orultrasound

17、,andarterialaccessisgainedbypercutaneouspunctureAlternatively,asurgicalcutdownisutilizedtoaccessthefemoralarteryAsmallerpercutaneoussheathisinsertedintothefemoralarteryonthecontralateralsideforplacementofapigtailcatheterintheascendingaortaforrootangiography文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Tran

18、sfemoral ApproachTheTAVIproceduremaybeperformedunderlocalorgeneralanesthesiaFollowingballoonvalvuloplasty,thevalveprosthesisispassedacrosstheaorticvalveandpositionedunderfluoroscopicandtransesophagealechocardiographic(TEE)guidance文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Transfemoral ApproachBalloon-ex

19、pandablevalvesaredeployedunderrapidventricularpacingatarateof160220bpmtominimizecardiacoutputandthereforeminimizeunintentionalmotionofthevalveduringballoondilatation文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Transapical ApproachThetransapicalapproachwasfirstdescrib

20、edin2006withballoon-expandablevalvesAsheathisplacedsurgicallyintheleftventricularapex,accessedthroughasmallleftanterolateralminithoracotomy文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Transapical ApproachFollowingballoonvalvuloplasty,thevalveprosthesisandballooncatheterarepassedoverawireintotheleftventric

21、leandpositionedwithintheaorticannulusunderfluoroscopicandtransesophagealechocardiographicguidance文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Transapical ApproachThisapproachmaybeconsiderediftheiliofemoralarterialsystemisofsufficientlysmalldiameter,calcified,ortortuousandnottechnicallysuitablefordeliveryo

22、fthedeviceAlsotakenintoconsiderationistheangulationoftheaortaandarch文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Transapical ApproachInparticular,atransverseorextremelyunfoldedascendingaortamayincreasethedifficultyofdeliveryandpositioningoftheballoon-expandabledevicesIthasbeensuggestedthatwithadvancesinde

23、vicetechnologyandareductionindeliverysystemprofilesforthetransarterialapproach,alternativeaccessapproacheswillbelimitedtolessthan30%ofTAVRprocedures文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Transapical ApproachContraindicationstothetransapicalapproachpreviousleftventricularsurgeryusingapatchcalcifiedpe

24、ricardiumsevererespiratorydisease文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Transapical Approach文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。OthersAxillary/SubclavianApproachTransaorticApproach文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Complications of TAVIProceduralComplicationsVascularComplicationsStrokeandNeur

25、ologicalEventsCoronaryOcclusionValveMalpositionandEmbolizationRenalImpairmentConductionDisturbance文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Complications of TAVIProsthesis-RelatedComplicationsProsthesisPatientMismatchParavalvularandValvularRegurgitationProstheticValveThrombosisandEndocarditis文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Question文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。THANKS