经皮主动脉瓣植入TAVI课件

Cliquez pour modifier le style du titre,Cliquez pour modifier les styles du texte du masque,Deuxime niveau,Troisime niveau,Quatrime niveau,Cinquime niveau,*,*,Cliquez pour modifier le style du titre,Cliquez pour modifier les styles du texte du masque,Deuxime niveau,Troisime niveau,Quatrime niveau,Cinquime niveau,*,Cliquez pour modifier le style du titre,Cliquez pour modifier les styles du texte du masque,Deuxime niveau,Troisime niveau,Quatrime niveau,Cinquime niveau,Cliquez pour modifier le style du titre,Cliquez pour modifier les styles du texte du masque,Deuxime niveau,Troisime niveau,Quatrime niveau,Cinquime niveau,*,Cliquez pour modifier le style du titre,Cliquez pour modifier les styles du texte du masque,Deuxime niveau,Troisime niveau,Quatrime niveau,Cinquime niveau,*,Cliquez pour modifier le style du titre,Cliquez pour modifier les styles du texte du masque,Deuxime niveau,Troisime niveau,Quatrime niveau,Cinquime niveau,*,Cliquez pour modifier le style du titre,Cliquez pour 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niveau,Troisime niveau,Quatrime niveau,Cinquime niveau,*,可编辑,*,Cliquez pour modifier le style du titre,Cliquez pour modifier les styles du texte du masque,Deuxime niveau,Troisime niveau,Quatrime niveau,Cinquime niveau,*,可编辑,*,TAVI,XIONGRAN 2014-11-25,TAVIXIONGRAN 2014-11-25,QUIZ,Street,Avenue,QUIZStreet,Street,Street,Avenue,Avenue,Hospital of UA,Hospital of UA,Hospital of UA,Hospital of UA,Hospital of UA,Hospital of UA,Hospital of UA,Hospital of UA,Summarize of TAVI,Transcatheter aortic valve implantation (TAVI),It was introduced as an alternative treatment in patients with severe aortic valve stenosis(AS),Cribier A, Eltchaninoff H, Bash A, Circulation 2002;106:30063008.,Summarize of TAVITranscatheter,First Case of TAVI,In 2002,Cribier et al demonstrated for the first time the feasibility of a percutaneous valve implantation in a patient with AS,Providing a promising less invasive alternative treatment for valvular heart disease,Cribier A, Eltchaninoff H, Bash A, Circulation 2002;106:30063008.,First Case of TAVIIn 2002, Cri,two different TAVI devices are widely used,the balloon-expandable Edwards SAPIEN Transcatheter Heart Valve,the self-expanding Medtronic CoreValve,Both received CE Mark approval for European commercial sale in 2007,Edwards SAPIEN valve received FDA pre-market approval in the USA in November 2011,Two different TAVI devices,two different TAVI devices are,Edwards balloonexpandable delivery systems,Edwards balloonexpandable deli,CoreValve ReValving System ( a ) schemata and ( b ) following deployment with aortography,CoreValve ReValving System ( a,Patients Selection,Feasible in most patients with severe aortic stenosis,Generally utilized in patients not suitable for surgical AVR, who are likely to derive functional and survival benefit,Two risk scores are used to calculate the risk of cardiac surgery,Patients SelectionFeasible in,“High-risk” surgical patients,Having a Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) at 30 days of greater than 10%,Logistic EuroSCORE of greater than 20 %,Limited,Do not account for several pertinent clinical risk factors, such as previous CABG, porcelain aorta, previous chest radiotherapy, severe lung disease, and liver cirrhosis,Two risk scores,“High-risk” surgical patients,Two risk scores,Two risk scores,Assessments of TAVI,To assess the aortic annulus dimensions and geometry, access site, and approach,Transthoracic echocardiography,Coronary angiography,Aortic angiography,MDCT,Assessments of TAVITo assess t,Assessment of arterial access,The evaluation is fundamental in the assessment of the TAVI patient in minimizing potential major vascular complications,Arterial dimensions,The presence or absence of atheroma,Calcification,Tortuosity,Assessment of arterial accessT,Assessment of arterial access,Arterial access is assessed with the combination of invasive angiography and contrast-enhanced CT,Iliofemoral assessment with (,a,) angiography and (,b,) MDCT,Assessment of arterial accessA,Assessment of aortic root,Using invasive angiography and contrast MDCT,evaluate root and valvular calcification,left main height from the left coronary cusp insertion (due to risk of coronary obstruction),technical issues related to each valve type and delivery system,European Heart Journal (2014) 35, 26272638,Assessment of aortic rootUsing,Assessment of aortic root,(,1,) aortic annulus diameter, (,2,) sinus of Valsalva width,(,3,) ascending aorta width, (,4,) sinus of Valsalva height,Assessment of aortic root( 1 ),Assessment of aortic root,Assessment of aortic root,THANK YOU,SUCCESS,2024/8/28,23,可编辑,THANK YOUSUCCESS2023/9/323,Assessments,Left and right heart catheterizations are also performed,assess the presence of pulmonary hypertension,coronary ischemia and the need for revascularization prior to TAVI,AssessmentsLeft and right hear,Requirements of TAVI,TAVI should be performed in regional centers of excellence with a dedicated heart valve program and high procedural volumes,The procedure may be undertaken in a cardiac catheterization laboratory with modifications or in a hybrid operating room equipped with high-quality fluoroscopic imaging,Requirements of TAVITAVI shoul,Requirements of TAVI,The facilities need to be large enough to accommodate sophisticated X-ray imaging integrated with echocardiography, cardiopulmonary bypass and intra-aortic balloon pump machines, and anesthesia equipment, with surgical sterility standards mandatory,Requirements of TAVIThe facili,Techniques of TAVI,TAVI is most often performed utilizing the transfemoral retrograde approach,Alternative access approaches usually reserved for patients with concomitant severe peripheral arterial disease,Techniques of TAVITAVI is most,Transfemoral Approach,The common femoral artery, at the level of the femoral head,is the primary access site for the transfemoral approach owing to its relatively large size and compressibility,The side with the largest and least diseased, tortuous, or calcified iliofemoral arteryas assessed by a screening angiogramand/or multidetector computed tomographic (CT) angiographyis selected for placement of the sheath,Transfemoral ApproachThe commo,Transfemoral Approach,The potential site of access is assessed fi rst with fluoroscopy and/or ultrasound, and arterial access is gained by percutaneous puncture,Alternatively, a surgical cutdown is utilized to access the femoral artery,A smaller percutaneous sheath is inserted into the femoral artery on the contralateral side for placement of a pigtail catheter in the ascending aorta for root angiography,Transfemoral ApproachThe poten,Transfemoral Approach,The TAVI procedure may be performed under local or general anesthesia,Following balloon valvuloplasty, the valve prosthesis is passed across the aortic valve and positioned under fluoroscopic and transesophageal echocardiographic (TEE) guidance,Transfemoral ApproachThe TAVI,Transfemoral Approach,Balloon-expandable valves are deployed under rapid ventricular pacing at a rate of 160220 bpm to minimize cardiac output and therefore minimize unintentional motion of the valve during balloon dilatation,Transfemoral ApproachBalloon-e,经皮主动脉瓣植入TAVI课件,Transapical Approach,The transapical approach was first described in 2006 with balloon-expandable valves,A sheath is placed surgically in the left ventricular apex, accessed through a small left anterolateral minithoracotomy,Transapical ApproachThe transa,Transapical Approach,Following balloon valvuloplasty, the valve prosthesis and balloon catheter are passed over a wire into the left ventricle and positioned within the aortic annulus under fluoroscopic and transesophageal echocardiographic guidance,Transapical ApproachFollowing,Transapical Approach,This approach may be considered if the iliofemoral arterial system is of sufficiently small diameter, calcified, or tortuous and not technically suitable for delivery of the device,Also taken into consideration is the angulation of the aorta and arch,Transapical ApproachThis appro,Transapical Approach,In particular, a transverse or extremely unfolded ascending aorta may increase the diffi culty of delivery and positioning of the balloon-expandable devices,It has been suggested that with advances in device technology and a reduction in delivery system profiles for the transarterial approach, alternative access approaches will be limited to less than 30 % of TAVR procedures,Transapical ApproachIn particu,Transapical Approach,Contraindications to the transapical approach,previous left ventricular surgery using a patch,calcified pericardium,severe respiratory disease,Transapical ApproachContraindi,Transapical Approach,Transapical Approach,Others,Axillary/Subclavian Approach,Transaortic Approach,OthersAxillary/Subclavian Appr,Complications of TAVI,Procedural Complications,Vascular Complications,Stroke and Neurological Events,Coronary Occlusion,Valve Malposition and Embolization,Renal Impairment,Conduction Disturbance,Complications of TAVIProcedura,Complications of TAVI,Prosthesis-Related Complications,ProsthesisPatient Mismatch,Paravalvular and Valvular Regurgitation,Prosthetic Valve Thrombosis and Endocarditis,Complications of TAVIProsthesi,Question,Question,THANKS,THANKS,THANK YOU,SUCCESS,2024/8/28,44,可编辑,THANK YOUSUCCESS2023/9/344,