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Cliquez pour modifier le style du titre,Cliquez pour modifier les styles du texte du masque,Deuxime niveau,Troisime niveau,Quatrime niveau,Cinquime niveau,*,TAVI,XIONGRAN 2014-11-25,QUIZ,Street,Avenue,Street,Avenue,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.,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.,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,Edwards balloonexpandable delivery systems,CoreValve ReValving System(a)schemata and(b)following deployment with aortography,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,“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,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,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 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 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 root,(,1,)aortic annulus diameter,(,2,)sinus of Valsalva width,(,3,)ascending aorta width,(,4,)sinus of Valsalva height,Assessment of aortic root,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,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 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,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,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 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 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,Transfe
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