Dworakowski R, Wendler O
Department of Cardiothoracic Surgery, King's College Hospital, London, UK.
Minerva Cardioangiol. 2012 Feb;60(1):71-83.
Transcatheter aortic valve implantation has been established as an alternative treatment option for those patients with aortic stenosis (AO), who are high risk or unsuitable for surgical aortic valve replacement. Since its introduction, transcatheter aortic valve implantation has been mainly performed either by a percutaneous approach through the femoral arteries or by using a transapical approach via a left-sided mini-thoracotomy. More recently, experience on alternative access routes such as the subclavian artery and the ascending aorta has been reported in a small number of patients. The Edwards SAPIENTM transcatheter heart valve (Edwards Lifesciences, Irvine, CA, USA) was the first balloon-expandable transcatheter heart valve to receive CE-Mark certification in Europe for transfemoral and transapical aortic valve implantation in 2007/2008. However, it also has been used for transcatheter procedures using access through ascending aorta and subclavian artery. Appropriate patient selection is key for a successful transcatheter aortic valve program and should be in the responsibility of the heart team of interventional cardiologists, cardiac surgeons, cardiac imaging specialists, anesthetists and geriatrists. Their mixture of skills will enable the team to build patient care pathways in which patients are assessed regarding cardiac and non-cardiac comorbidities, the most appropriate type of treatment is jointly agreed, and finally various treatment options are delivered. In this review we highlight the cornerstones of a successful transcatheter aortic valve program using the Edwards SAPIENTM valve. We focus in particular on preoperative diagnostics, patient selection and potential strengths and weaknesses of the various access routes to offer a guideline for future experience.
经导管主动脉瓣植入术已成为主动脉瓣狭窄（AO）患者的一种替代治疗选择，这些患者具有高手术风险或不适合进行外科主动脉瓣置换术。自引入以来，经导管主动脉瓣植入术主要通过经股动脉的经皮途径或经左侧小切口的经心尖途径进行。最近，少数患者报告了锁骨下动脉和升主动脉等替代入路的经验。爱德华兹SAPIEN™经导管心脏瓣膜（美国加利福尼亚州欧文市爱德华兹生命科学公司）是2007/2008年在欧洲获得CE标志认证的首个球囊扩张式经导管心脏瓣膜，用于经股动脉和经心尖主动脉瓣植入。然而，它也已用于通过升主动脉和锁骨下动脉入路的经导管手术。合适的患者选择是成功的经导管主动脉瓣项目的关键，应由介入心脏病学家、心脏外科医生、心脏影像专家、麻醉师和老年病学家组成的心脏团队负责。他们的技能组合将使团队能够建立患者护理路径，在此路径中，对患者的心脏和非心脏合并症进行评估，共同商定最合适的治疗类型，最后提供各种治疗选择。在本综述中，我们重点介绍使用爱德华兹SAPIEN™瓣膜成功开展经导管主动脉瓣项目的基石。我们特别关注术前诊断、患者选择以及各种入路的潜在优缺点，以为未来的经验提供指导。
