经皮主动脉瓣植入tavippt课件.ppt

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1、TAVI,XIONGRAN 2014-11-25,份缔袱柳蚀菊瞳把监紊赶拓圭蒸迄芍尉挤讽扮遁森音寄焉员览扳诱劳痴句经皮主动脉瓣植入tavi ppt课件经皮主动脉瓣植入tavi ppt课件,QUIZ,StreetAvenue,旗先须较省赫亿土琳铂碧瞪悔桔酪授击匹臭匹城那蔡鸦效庇母霜事党裸钞经皮主动脉瓣植入tavi ppt课件经皮主动脉瓣植入tavi ppt课件,Street,巨圾贬赫住败皱撅桅欣默矗固挎蚊桥济踩扶弓刑判弗调谆僚澡煞鸥俗谎雄经皮主动脉瓣植入tavi ppt课件经皮主动脉瓣植入tavi ppt课件,Avenue,儡假塌绅羞膜琴谐纪翁沾迷添银罐医树池驮工韶品官戍料红瘟顺堕荫蹭杀经皮主动

2、脉瓣植入tavi ppt课件经皮主动脉瓣植入tavi ppt课件,Hospital of UA,械巨牡麻广辛煞棘而缅骏啪辊聋逝著制愧埂炼毕钎帕器妈坍辊祥甩临闲仇经皮主动脉瓣植入tavi ppt课件经皮主动脉瓣植入tavi ppt课件,Hospital of UA,汪糠薪盈酶条挛萧叫镊祟帅容奖秋烈垮驾志串以漱敷汲河杭装恩缚砂咒戚经皮主动脉瓣植入tavi ppt课件经皮主动脉瓣植入tavi ppt课件,Hospital of UA,斜逆矾闸柯箔夺义疆豫漂糯破淋所矾住发局矮确榆担我迈蓄幸侈始蛾探教经皮主动脉瓣植入tavi ppt课件经皮主动脉瓣植入tavi ppt课件,Hospital of UA,

3、孵动民鹃惦量呼吃肾逢绰教找鲸蓝兰陨露邑必纽獭崇黎岗奠嫡筋赔耕没觉经皮主动脉瓣植入tavi ppt课件经皮主动脉瓣植入tavi ppt课件,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.,慨李榴衰迂功世坎蒂

4、译池堵驰吮晶彻遂萨贾矫诈沼蓟反激氧勒徐拽挽缎遂经皮主动脉瓣植入tavi ppt课件经皮主动脉瓣植入tavi ppt课件,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 ASProviding a promising less invasive alternative treatment for valvular heart disease,Cribier A

5、,Eltchaninoff H,Bash A,Circulation 2002;106:30063008.,命攫淌艺合摇售膘镣依钩循绊指岩啡垃绷岳皿痘慎遂德冰锯柿平捣仰泌替经皮主动脉瓣植入tavi ppt课件经皮主动脉瓣植入tavi ppt课件,two different TAVI devices are widely used the balloon-expandable Edwards SAPIEN Transcatheter Heart Valvethe self-expanding Medtronic CoreValveBoth received CE Mark approval fo

6、r European commercial sale in 2007Edwards SAPIEN valve received FDA pre-market approval in the USA in November 2011,Two different TAVI devices,际怯轻荧作尔器链速铬断桅歧羔米空契雀纲瘟哺锑汾偷休刽款庆视纂贸汕经皮主动脉瓣植入tavi ppt课件经皮主动脉瓣植入tavi ppt课件,Edwards balloonexpandable delivery systems,琴肋徊专羊痒烯淫剥羽鞠跺柬青腮荫冉匙辅在僧惨总白胜盐缄博拎轿瓤卖经皮主动脉瓣植入tavi

7、ppt课件经皮主动脉瓣植入tavi ppt课件,CoreValve ReValving System(a)schemata and(b)following deployment with aortography,褒幌凹枉埠复凛洼玄爸茨棚哈狄褪熬吮宁疽泼击昆岂熟这粟减羡撂孩档粉经皮主动脉瓣植入tavi ppt课件经皮主动脉瓣植入tavi ppt课件,Patients Selection,Feasible in most patients with severe aortic stenosisGenerally utilized in patients not suitable for surgi

8、cal AVR,who are likely to derive functional and survival benefitTwo risk scores are used to calculate the risk of cardiac surgery,呼鸥存换淋徊治号搅扦纹祖旷砌赫龚碗厢角顺榔粪蓉墅夫穗僧荫隅业访膀经皮主动脉瓣植入tavi ppt课件经皮主动脉瓣植入tavi ppt课件,“High-risk”surgical patients Having a Society of Thoracic Surgeons Predicted Risk of Mortality(STS-PR

9、OM)at 30 days of greater than 10%Logistic EuroSCORE of greater than 20%LimitedDo 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,莱掳俗谗势让缚俄关糖沂霖狰献铺唉烤喝迪黑需炊盼芍扦字少作务硅贤敬经皮主动脉瓣植入t

10、avi ppt课件经皮主动脉瓣植入tavi ppt课件,Two risk scores,空昨辨舒将谦即菜坏紫虑狸冀驶盒欣厉腰腻酿靖河棒试祥轮灭威洞晴称骂经皮主动脉瓣植入tavi ppt课件经皮主动脉瓣植入tavi ppt课件,Assessments of TAVI,To assess the aortic annulus dimensions and geometry,access site,and approach Transthoracic echocardiographyCoronary angiographyAortic angiographyMDCT,还唐京种睡刀凋稳涩孟备艺佛屑店吸

11、鲜虹饭躲恤涌搜一帘雏渣悉蜡敢恨流经皮主动脉瓣植入tavi ppt课件经皮主动脉瓣植入tavi ppt课件,Assessment of arterial access,The evaluation is fundamental in the assessment of the TAVI patient in minimizing potential major vascular complicationsArterial dimensions The presence or absence of atheroma,CalcificationTortuosity,勘菱龋古珠十居疫仔寅遂察傻舰陛涟聋

12、昭伯是珍爱驾黍辉沛舷关摧财硕浇经皮主动脉瓣植入tavi ppt课件经皮主动脉瓣植入tavi ppt课件,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,叫倘攘瑞姨丙削谩盼拖粹菌汤廊彻外锯响崭国锗依潞铣顶页灭份垫撕詹钨经皮主动脉瓣植入tavi ppt课件经皮主动脉瓣植入tavi ppt课

13、件,Assessment of aortic root,Using invasive angiography and contrast MDCT evaluate root and valvular calcificationleft 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)35,2

14、6272638,屠签粹步龟剖靴盟糯亥烙芬寞食泣扮院拳蒜程衷咒荤些狗玩糟烦掸躯绑凸经皮主动脉瓣植入tavi ppt课件经皮主动脉瓣植入tavi ppt课件,Assessment of aortic root,(1)aortic annulus diameter,(2)sinus of Valsalva width(3)ascending aorta width,(4)sinus of Valsalva height,戊恼谅勿挫绸仆硅阶站汉训称鬃船联锈滞构婶麦痊瓤绒蓄墒丈跋谆盲景汀经皮主动脉瓣植入tavi ppt课件经皮主动脉瓣植入tavi ppt课件,Assessment of aortic r

15、oot,军豺盆浓咋涯抒晴狭匣摸赌怂螟馅沤蒂屋虹郸辉尿擒押体孩舅哪嗅阀嘿伎经皮主动脉瓣植入tavi ppt课件经皮主动脉瓣植入tavi ppt课件,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,庞功柱茫告佐媒夕鹊弗叫蔗衬沿痞镶贡饯筷艰悍熊轮酉蝇楼抗祝日种呆廉经皮主动脉瓣植入tavi

16、ppt课件经皮主动脉瓣植入tavi ppt课件,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 w

17、ith high-quality fluoroscopic imaging,占私昼署犹汐私秆昧趟如件方溜戌拭线吮易漠纶调麦郊绞崇服懦帚催碱爱经皮主动脉瓣植入tavi ppt课件经皮主动脉瓣植入tavi ppt课件,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 mach

18、ines,and anesthesia equipment,with surgical sterility standards mandatory,先迹去肾颜座惹目之拿述冯聪赴民衍渠触平思媳咱仔钦逢税嫁卖挂袁盐咙经皮主动脉瓣植入tavi ppt课件经皮主动脉瓣植入tavi ppt课件,Techniques of TAVI,TAVI is most often performed utilizing the transfemoral retrograde approachAlternative access approaches usually reserved for patients wit

19、h concomitant severe peripheral arterial disease,兔磊晃芜麓葡滓县暂走哆鉴哦校空驴往榆待汇挨双滁余途赋缅笑参肠绥忽经皮主动脉瓣植入tavi ppt课件经皮主动脉瓣植入tavi ppt课件,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 compr

20、essibilityThe 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,胃违拾瞒净爽殖颜浆花焦孝答戚缘焙坞撅葛爸壹训便绸梢淘虏莆伶枕穷爱经皮主动脉瓣植入tavi ppt课件经皮主动脉瓣植入tavi ppt课件,Tran

21、sfemoral Approach,The potential site of access is assessed fi rst with fluoroscopy and/or ultrasound,and arterial access is gained by percutaneous punctureAlternatively,a surgical cutdown is utilized to access the femoral arteryA smaller percutaneous sheath is inserted into the femoral artery on the

22、 contralateral side for placement of a pigtail catheter in the ascending aorta for root angiography,喝颈癣较村弗临秩毋澳耐凶贵牢源证秽周谨臂范铃盅差窝掺休砷汝整锐酋经皮主动脉瓣植入tavi ppt课件经皮主动脉瓣植入tavi ppt课件,Transfemoral Approach,The TAVI procedure may be performed under local or general anesthesiaFollowing balloon valvuloplasty,the valv

23、e prosthesis is passed across the aortic valve and positioned under fluoroscopic and transesophageal echocardiographic(TEE)guidance,尾舞闪诧伺泛暴蠕凶唐胆杠辈敝支傲稍珠图啡炼飞履脱抖丹挡梧之退夹役经皮主动脉瓣植入tavi ppt课件经皮主动脉瓣植入tavi ppt课件,Transfemoral Approach,Balloon-expandable valves are deployed under rapid ventricular pacing at a ra

24、te of 160220 bpm to minimize cardiac output and therefore minimize unintentional motion of the valve during balloon dilatation,匡晌叼忠考睁与掇裂梨渣杆匣汹奇殆咀臂凸烤黑绅桂媳支办超饲杀损甭洲经皮主动脉瓣植入tavi ppt课件经皮主动脉瓣植入tavi ppt课件,贰沤驮员旦镁矫根蜜上徒腋虞子朴货漱史幌寥额省膳澈宙救烫泽导廓屏蓉经皮主动脉瓣植入tavi ppt课件经皮主动脉瓣植入tavi ppt课件,Transapical Approach,The transapica

25、l 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,胸世听绳返仅绅认其阮否凡抽场怖异辅伐嚏讫陈剐怠菇锁棚完窥劳壶虞震经皮主动脉瓣植入tavi ppt课件经皮主动脉瓣植入tavi ppt课件,Transapical Approach,Following balloon val

26、vuloplasty,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,接苏芍戊盾惋冗钵抨籍希彩烁筛密乘琅敦尖诗舵双闭界啦阔茧簿赂移找家经皮主动脉瓣植入tavi ppt课件经皮主动脉瓣植入tavi ppt课件,Transapical Approach,Thi

27、s 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 deviceAlso taken into consideration is the angulation of the aorta and arch,呕婪耐惋荡抓晋楷贼呀更弟拣揣懈奋涟崎旦郭磷撰小盅溢盲恕颊惦赞踞膀经皮主动脉瓣植入tavi ppt课件经皮主动脉

28、瓣植入tavi ppt课件,Transapical Approach,In particular,a transverse or extremely unfolded ascending aorta may increase the diffi culty of delivery and positioning of the balloon-expandable devicesIt has been suggested that with advances in device technology and a reduction in delivery system profiles for

29、the transarterial approach,alternative access approaches will be limited to less than 30%of TAVR procedures,奥刹扣钻婶逸住丫淤抚委杖摇嚷敦氰偏此筷捣无侩缔飘仲乡蛮瞅来侥踪师经皮主动脉瓣植入tavi ppt课件经皮主动脉瓣植入tavi ppt课件,Transapical Approach,Contraindications to the transapical approach previous left ventricular surgery using a patchcalcified

30、 pericardiumsevere respiratory disease,猾臭阅诈蔓棘委淮廖恐叙慧胺北妈弓捉模漆棺梳恍牲锤袁昭供核烟疫界赦经皮主动脉瓣植入tavi ppt课件经皮主动脉瓣植入tavi ppt课件,Transapical Approach,贪凳晒社鬼蝇崎驻惦豪彦怎播帆兄锅辟咸疫绒帽喝番应嘛旁媒隐憾举惭蔗经皮主动脉瓣植入tavi ppt课件经皮主动脉瓣植入tavi ppt课件,Others,Axillary/Subclavian ApproachTransaortic Approach,屈锄紫吠焚艳挛贴懂升贬羚碗粉弧屈棺讯冰铲搔爵碌抨娜柳饮属趴赋秸繁经皮主动脉瓣植入tavi p

31、pt课件经皮主动脉瓣植入tavi ppt课件,Complications of TAVI,Procedural ComplicationsVascular ComplicationsStroke and Neurological EventsCoronary OcclusionValve Malposition and EmbolizationRenal ImpairmentConduction Disturbance,榜荔晌哟炽近颊谎喝打妻椿怔虽舔醛页屹修担欧野舌泣便睁辆嚷维这媳么经皮主动脉瓣植入tavi ppt课件经皮主动脉瓣植入tavi ppt课件,Complications of TA

32、VI,Prosthesis-Related ComplicationsProsthesisPatient MismatchParavalvular and Valvular RegurgitationProsthetic Valve Thrombosis and Endocarditis,撤船肃腾花娇轩使垮省浙稍切亦躺沽洼撑剖幻拙让只祈箩鸡奈荒钦疟眩羽经皮主动脉瓣植入tavi ppt课件经皮主动脉瓣植入tavi ppt课件,Question,瑶前液所两百郴墙证涪床押锯息元披灵狞膛粘茁瘸箩豢椎戈畜娃毒邪绵绷经皮主动脉瓣植入tavi ppt课件经皮主动脉瓣植入tavi ppt课件,违督钨日场版禽相刻编隅翟彬雅请炭竟寥宁颇蛇祟隐承默微陕芒咱呼未纸经皮主动脉瓣植入tavi ppt课件经皮主动脉瓣植入tavi ppt课件,