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严重主动脉瓣狭窄的定义对于左心室收缩功能正常的患者：主瓣峰值血流速度4.0 m/s(对应跨主瓣峰值压差64 mm Hg),平均压差40 mm Hg,或主瓣瓣口面积4.Patient Selection:Inclusion and Exclusion Criteria in Clinical Trials,Irvine,CA)：三瓣牛心包瓣固定在可球囊扩张的钴铬合金支架上。房间要足够温暖，甚至应用体下供热系统。严重主动脉瓣狭窄的治疗选择对于左心室收缩功能正常的患者：,Irvine,CA)：三瓣牛心包瓣固定在可球囊扩张的钴铬合金支架上。With severe,symptomatic,calcific AS,AVR is the only effective treatment that improves symptoms and prolongs survival(30,31).考虑到患者体表面积不同，主瓣面积常用体表面积指数表示，0.实际上，应用现代生物瓣，术后5年有95的患者瓣膜仍然良好，不必再次手术；This valve has only been used by a retrograde approacheither via transfemoral,subclavian,or严重主动脉瓣狭窄的治疗选择Table 7.Quality of Life and Symptom Assessment in TAVR Trialsdirect aortic access.Table 7.2222Table 9.Patient Selection:Inclusion and Exclusion Criteria in Clinical TrialsTable 9.Patient Selection:In2323Table 9.Patient Selection:Inclusion and Exclusion Criteria in Clinical TrialsTable 9.Patient Selection:In2424TAVR所需图像设备心脏彩超CT心脏磁共振观察主动脉瓣、瓣环、瓣环距冠状动脉的距离、升主动脉、髂股动脉情况。TAVR所需图像设备心脏彩超2525人员心内科、心外科人员心内科、心外科2626手术场所杂交手术室设备齐全的、宽敞的、有双球管的C型臂。手术场所杂交手术室2727麻醉及术中监护项目全麻肺动脉导管，经食管超声，临时起搏器，除颤仪。房间要足够温暖，甚至应用体下供热系统。避免过长时间低血压。麻醉及术中监护项目全麻2828股动脉途径穿刺或切开均可，依据具体情况，各有利弊。股动脉途径穿刺或切开均可，依据具体情况，各有利弊。2929效果评价效果评价效果评价3030并发症并发症并发症3131新新TAVRTAVR瓣膜瓣膜新TAVR瓣膜3232ASAS治疗方法选择治疗方法选择AS治疗方法选择33336 cm2/m2 作为严重主瓣狭窄的标准.Major Outcomes at 30 Days and 1 Year in Cohort B of the PARTNER TrialDespite substantial contemporary experience with successful AVR in elderly patients,multiple series have documented that 30%to 40%of patients with severe AS do not undergo surgery owing to advanced age,LV dysfunction,multiple coexisting conditions,and patient preference or physician recommendation。An estimated 40,000 patients have received TAVR worldwide.严重主动脉瓣狭窄的治疗选择设备齐全的、宽敞的、有双球管的C型臂。,Irvine,CA)：三瓣牛心包瓣固定在可球囊扩张的钴铬合金支架上。6 cm2/m2 作为严重主瓣狭窄的标准.Major Outcomes at 30 Days and 1 Year in Cohort B of the PARTNER TrialMultiple single and multicenter registries,and a single randomized trial,have documented favorable outcomes using a wide spectrum of endpoints,including survival,symptom status,quality of life,and need for repeat hospitalization.常会发生生物瓣叶的钙化。Major Outcomes at 30 Days and 1 Year in Cohort B of the PARTNER TrialIt is available in 3 sizes26 mm,29 mm,and 31 mm.严重主动脉瓣狭窄的治疗选择This valve has only been used by a retrograde approacheither via transfemoral,subclavian,orRandomized Controlled TrialPARTNER Trial Design常会发生生物瓣叶的钙化。Cohort A-high-risk operable,699人;A prospective,unblinded,randomized,controlled,multicenter pivotal trial evaluating the safety and effectiveness of the Edwards Sapien THV transcatheter aortic valve;This valve has only been used by a retrograde approacheither via transfemoral,subclavian,orRestenosis or recoil of the aortic valve usually occurs within 6 months.0 m/s(对应跨主瓣峰值压差64 mm Hg),平均压差40 mm Hg,或主瓣瓣口面积1.我国TAVR现状少数几个大医院。国产TAVR瓣膜即将应用于临床。6 cm2/m2 作为严重主瓣狭窄的标准.我国TAVR现状少3434
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