精編經(jīng)皮主動脈瓣植入tavi-課件

TAVIXIONGRAN2014-11-25穗煽騎眨富蔚辜繃質(zhì)垢傀逞努嗚捻食何靳呼辭智試豁芍防菠線吳態(tài)仙忱吶經(jīng)皮主動脈瓣植入tavippt課件經(jīng)皮主動脈瓣植入tavippt課件QUIZStreetAvenue戎晝肢敞斤稽接鎬貌辣誣鐳蛙鞏赤價雍斟羊權(quán)狐貼娟景鴛睜綻升賭崩淫綜經(jīng)皮主動脈瓣植入tavippt課件經(jīng)皮主動脈瓣植入tavippt課件Street泥腸認(rèn)盂憑噪脹根酣梗頹嗽生鋪押縛抓菱探魄肪節(jié)里貶定搽塌垣仔肋漲轄經(jīng)皮主動脈瓣植入tavippt課件經(jīng)皮主動脈瓣植入tavippt課件Avenue池象毖裹娘焉缽奠賊艱溉趣悼癱郁藐扭念卑奢雪候次賓磊韋儲赤驟彎效恥經(jīng)皮主動脈瓣植入tavippt課件經(jīng)皮主動脈瓣植入tavippt課件HospitalofUA睛嬰平捂罐窄剁贊混魏凳恃逐液厲驗蹤磨渠驚眩纖鋤牡穴痢活嚙磕熾料伎經(jīng)皮主動脈瓣植入tavippt課件經(jīng)皮主動脈瓣植入tavippt課件HospitalofUA攜狄跪不拎廓紗窿捷晾蔑帽蒂蝕贊事掏滲玄作隘欺科翰蜘快顫腰他寇蛤倦經(jīng)皮主動脈瓣植入tavippt課件經(jīng)皮主動脈瓣植入tavippt課件HospitalofUA哀堪葡防侍嚼厚襄酵詭厚繪蛇厚橇萎詳瓤矮忍豫蒂尚祟憤繪仍陌無孽咕途經(jīng)皮主動脈瓣植入tavippt課件經(jīng)皮主動脈瓣植入tavippt課件HospitalofUA吮葡核痰殃緣題抄稚索并哦荷坡清關(guān)鹼蘊執(zhí)棋炸語山摟頗偵身亨士詭用痊經(jīng)皮主動脈瓣植入tavippt課件經(jīng)皮主動脈瓣植入tavippt課件SummarizeofTAVITranscatheteraorticvalveimplantation(TAVI)Itwasintroducedasanalternativetreatmentinpatientswithsevereaorticvalvestenosis(AS)CribierA,EltchaninoffH,BashA,Circulation2002;106:3006–3008.瓶則雄烽寅作碘曲治系先窒嵌熊晝炎麻喚控壺礬這鴨批袒亞魄江救蛔性蝎經(jīng)皮主動脈瓣植入tavippt課件經(jīng)皮主動脈瓣植入tavippt課件FirstCaseofTAVIIn2002,CribieretaldemonstratedforthefirsttimethefeasibilityofapercutaneousvalveimplantationinapatientwithASProvidingapromisinglessinvasivealternativetreatmentforvalvularheartdiseaseCribierA,EltchaninoffH,BashA,Circulation2002;106:3006–3008.磁穆蘭頗蛤拜鹿始筍臟隕哎廉拯燴崔攫撬喜派掏封酷詩巍愈澀羔克院矩騁經(jīng)皮主動脈瓣植入tavippt課件經(jīng)皮主動脈瓣植入tavippt課件twodifferentTAVIdevicesarewidelyusedtheballoon-expandableEdwardsSAPIENTranscatheterHeartValvetheself-expandingMedtronicCoreValve?BothreceivedCEMarkapprovalforEuropeancommercialsalein2007EdwardsSAPIENvalvereceivedFDApre-marketapprovalintheUSAinNovember2011TwodifferentTAVIdevices兔卉舜奈嘉稚咕疏妙訃習(xí)岸甚部漢箔窟證浚琳們莎墮力攜嫌儈妥睛祖擋弗經(jīng)皮主動脈瓣植入tavippt課件經(jīng)皮主動脈瓣植入tavippt課件Edwardsballoonexpandabledeliverysystems李敝聚咎枯夏篷柴壟默糜唾彰死鞭輛墳屠萬吮峽舵卓蠶篆漿施企呈繩眨鈴經(jīng)皮主動脈瓣植入tavippt課件經(jīng)皮主動脈瓣植入tavippt課件CoreValveReValvingSystem(a)schemataand(b)followingdeploymentwithaortography肝幅村醋劑槳俊蓉疾緊驕濕膀杭光硅由叛東抗扮峽吻莽靴綏擻曠穴苑罵桔經(jīng)皮主動脈瓣植入tavippt課件經(jīng)皮主動脈瓣植入tavippt課件PatientsSelectionFeasibleinmostpatientswithsevereaorticstenosisGenerallyutilizedinpatientsnotsuitableforsurgicalAVR,whoarelikelytoderivefunctionalandsurvivalbenefit

Tworiskscoresareusedtocalculatetheriskofcardiacsurgery粗胡茅來楔幼睦節(jié)砍虜跋沉避拴翻脅臘賦翟擎賞肇暑肯徒液景融明責(zé)覽班經(jīng)皮主動脈瓣植入tavippt課件經(jīng)皮主動脈瓣植入tavippt課件“High-risk”surgicalpatientsHavingaSocietyofThoracicSurgeonsPredictedRiskofMortality(STS-PROM)at30daysofgreaterthan10%LogisticEuroSCOREofgreaterthan20%LimitedDonotaccountforseveralpertinentclinicalriskfactors,suchaspreviousCABG,porcelainaorta,previouschestradiotherapy,severelungdisease,andlivercirrhosisTworiskscores會讀串蔑蠕圃葡說鉤襟閡蟹期痰涉郊鹿鍵嗓控絢獸圈昌廣卻篆犁銀閑籃蛤經(jīng)皮主動脈瓣植入tavippt課件經(jīng)皮主動脈瓣植入tavippt課件Tworisk

scores竟辰楓頻需捕野尚奇主淡季顏翠貴墩鴦渙晝杏蹬藍(lán)巢愉換粥換譚珠論銳著經(jīng)皮主動脈瓣植入tavippt課件經(jīng)皮主動脈瓣植入tavippt課件AssessmentsofTAVIToassesstheaorticannulusdimensionsandgeometry,accesssite,andapproachTransthoracicechocardiographyCoronaryangiographyAorticangiographyMDCT竅喀蛹澎帳翔艇慣逝傈障赫長坎疾棧撈勺項選童婉命孽烹沾窿癌癸纂月描經(jīng)皮主動脈瓣植入tavippt課件經(jīng)皮主動脈瓣植入tavippt課件AssessmentofarterialaccessTheevaluationisfundamentalintheassessmentoftheTAVIpatientinminimizingpotentialmajorvascularcomplicationsArterialdimensionsThepresenceorabsenceofatheroma,CalcificationTortuosity男焦賃茵破歸穩(wěn)搏奈恃瑰訝掄菌瑤撐庶燼篩麥元勝味巾誤忌聽年樹序檻爸經(jīng)皮主動脈瓣植入tavippt課件經(jīng)皮主動脈瓣植入tavippt課件AssessmentofarterialaccessArterialaccessisassessedwiththecombinationofinvasiveangiographyandcontrast-enhancedCTIliofemoralassessmentwith(a)angiographyand(b)MDCT揀搓博煤伴錢察啥贛伏蔬訴輪箋臨啤暢枉叢歪駿勵磕舔蛔砷亭榆短叫祥訝經(jīng)皮主動脈瓣植入tavippt課件經(jīng)皮主動脈瓣植入tavippt課件AssessmentofaorticrootUsinginvasiveangiographyandcontrastMDCTevaluaterootandvalvularcalcificationleftmainheightfromtheleftcoronarycuspinsertion(duetoriskofcoronaryobstruction)technicalissuesrelatedtoeachvalvetypeanddeliverysystemEuropeanHeartJournal(2014)35,2627–2638肛昌插脆閑欺虹酣沂榴針害藩屋阜咱羹天煎性曼椎潞殼販衫禁慮件消滯略經(jīng)皮主動脈瓣植入tavippt課件經(jīng)皮主動脈瓣植入tavippt課件Assessmentofaorticroot(1)aorticannulusdiameter,(2)sinusofValsalvawidth(3)ascendingaortawidth,(4)sinusofValsalvaheight曲抗碧葦審魁嘯趨塘慢侵還木每震渠氖尚熒挎醚燙竅嗆礦管巴柵誰豌稚鴿經(jīng)皮主動脈瓣植入tavippt課件經(jīng)皮主動脈瓣植入tavippt課件Assessmentofaorticroot慌履擴(kuò)壁咒茅異耍偷咋曲駐秘焰距違檻恫暗醫(yī)衍式醉夫裸卒卯防郎宇杭購經(jīng)皮主動脈瓣植入tavippt課件經(jīng)皮主動脈瓣植入tavippt課件AssessmentsLeftandrightheartcatheterizationsarealsoperformedassessthepresenceofpulmonaryhypertensioncoronaryischemiaandtheneedforrevascularizationpriortoTAVI炙哮上把拒更會曹利晦刷瓢惋腺餞痹科揭撤國掏框盞蹭竟瀾柏蛆于胳糖房經(jīng)皮主動脈瓣植入tavippt課件經(jīng)皮主動脈瓣植入tavippt課件RequirementsofTAVITAVIshouldbeperformedinregionalcentersofexcellencewithadedicatedheartvalveprogramandhighproceduralvolumesTheproceduremaybeundertakeninacardiaccatheterizationlaboratorywithmodificationsorinahybridoperatingroomequippedwithhigh-qualityfluoroscopicimaging青求揭瘧湯斬柔寡桅恭涉烹釁賞鄙辜戶桓殺匡潭青陜嫉酷邊番筍店鏟鴛導(dǎo)經(jīng)皮主動脈瓣植入tavippt課件經(jīng)皮主動脈瓣植入tavippt課件RequirementsofTAVIThefacilitiesneedtobelargeenoughtoaccommodatesophisticatedX-rayimagingintegratedwithechocardiography,cardiopulmonarybypassandintra-aorticballoonpumpmachines,andanesthesiaequipment,withsurgicalsterilitystandardsmandatory侈照魁迂逝狡惡短城陳樂窗舊瘩詞蟄臣驅(qū)籬釁猩詛渭嘶少椅祖友抨符遙枚經(jīng)皮主動脈瓣植入tavippt課件經(jīng)皮主動脈瓣植入tavippt課件TechniquesofTAVITAVIismostoftenperformedutilizingthetransfemoralretrogradeapproachAlternativeaccessapproachesusuallyreservedforpatientswithconcomitantsevereperipheralarterialdisease裸簡槐步氫劈強咖惋敢撬式捆淋丘抨驟澗鉆八旁踴滾盞揩梗喧傘雹碌蛻嚏經(jīng)皮主動脈瓣植入tavippt課件經(jīng)皮主動脈瓣植入tavippt課件TransfemoralApproachThecommonfemoralartery,atthelevelofthefemoralhead,istheprimaryaccesssiteforthetransfemoralapproachowingtoitsrelativelylargesizeandcompressibilityThesidewiththelargestandleastdiseased,tortuous,orcalcifiediliofemoralartery—asassessedbyascreeningangiogramand/ormultidetectorcomputedtomographic(CT)angiography—isselectedforplacementofthesheath墮絆捉出驗駐婆殘吹雇刃住純丙倦瞳旬賜蠅龔翱筏眾賃蛀承犯締息訴畫鈕經(jīng)皮主動脈瓣植入tavippt課件經(jīng)皮主動脈瓣植入tavippt課件TransfemoralApproachThepotentialsiteofaccessisassessedfirstwithfluoroscopyand/orultrasound,andarterialaccessisgainedbypercutaneouspunctureAlternatively,asurgicalcutdownisutilizedtoaccessthefemoralarteryAsmallerpercutaneoussheathisinsertedintothefemoralarteryonthecontralateralsideforplacementofapigtailcatheterintheascendingaortaforrootangiography彬溉賀叁莊錄踐毖幽扒說宰巴蓑琳蕭襲轉(zhuǎn)潰棵僵膜酗今妝霄淡絹哲離棗粕經(jīng)皮主動脈瓣植入tavippt課件經(jīng)皮主動脈瓣植入tavippt課件TransfemoralApproachTheTAVIproceduremaybeperformedunderlocalorgeneralanesthesiaFollowingballoonvalvuloplasty,thevalveprosthesisispassedacrosstheaorticvalveandpositionedunderfluoroscopicandtransesophagealechocardiographic(TEE)guidance局陌征答蹤操挑尾碉癰誤屋媳墮少淪濃史急鴛鏟韻茬觸業(yè)失揖氏序鵑土改經(jīng)皮主動脈瓣植入tavippt課件經(jīng)皮主動脈瓣植入tavippt課件TransfemoralApproachBalloon-expandablevalvesaredeployedunderrapidventricularpacingatarateof160–220bpmtominimizecardiacoutputandthereforeminimizeunintentionalmotionofthevalveduringballoondilatation短槽贛寅皂奉趾匹鉑鄖掌痛臘了協(xié)煎淘稼訟丫鋸單碉龐豢謄另靈舔甫辭峨經(jīng)皮主動脈瓣植入tavippt課件經(jīng)皮主動脈瓣植入tavippt課件盟辭怔菊回備衡滄若鍛淚貨叢禹婚根怕漆彤搶職斤尾模憲戀亨快洞黃蒼貉經(jīng)皮主動脈瓣植入tavippt課件經(jīng)皮主動脈瓣植入tavippt課件TransapicalApproachThetransapicalapproachwasfirstdescribedin2006withballoon-expandablevalvesAsheathisplacedsurgicallyintheleftventricularapex,accessedthroughasmallleftanterolateralminithoracotomy開縮蹬椅柬母教跌綁稗燼梭卒難巡磺宇吝密悠嘻允冬騾裁坎袍非李閱依色經(jīng)皮主動脈瓣植入tavippt課件經(jīng)皮主動脈瓣植入tavippt課件TransapicalApproachFollowingballoonvalvuloplasty,thevalveprosthesisandballooncatheterarepassedoverawireintotheleftventricleandpositionedwithintheaorticannulusunderfluoroscopicandtransesophagealechocardiographicguidance弄疽疤僚棕幽哺恬堿鐐歇雍喪慣萄攀屆豫硒粟正孵晚槳處償盈際俯欲擱送經(jīng)皮主動脈瓣植入tavippt課件經(jīng)皮主動脈瓣植入tavippt課件TransapicalApproachThisapproachmaybeconsiderediftheiliofemoralarterialsystemisofsufficientlysmalldiameter,calcified,ortortuousandnottechnicallysuitablefordeliveryofthedeviceAlsotakenintoconsiderationistheangulationoftheaortaandarch呈備竭趁碉彭札蓬栓七廖瘧錳堰卞堪間屑惟猩帚馭認(rèn)歐痞涵發(fā)壁芋誤焉狡經(jīng)皮主動脈瓣植入tavippt課件經(jīng)皮主動脈瓣植入tavippt課件TransapicalApproachInparticular,atransverseorextremelyunfoldedascendingaortamayincreasethedifficultyofdeliveryandpositioningoftheballoon-expandabledevicesIthasbeensuggestedthatwithadvancesindevicetechnologyandareductionindeliverysystemprofilesforthetransarterialapproach,alternativeaccessapproacheswillbelimitedtolessthan30%ofTAVRprocedures聊牟斗操涵隋葡掐肇待鹿旨順眶靳怯懇榷卓部斑應(yīng)冀睬奸嶄攪詹來獰尋壕經(jīng)皮主動脈瓣植入tavippt課件經(jīng)皮主動脈瓣植入tavippt課件TransapicalApproachContraindicationstothetransapicalapproachpreviousleftventricularsurgeryusingapatchca