Ramlawi Basel, Anaya-Ayala Javier E, Reardon Michael J
Methodist DeBakey Heart & Vascular Center, The Methodist Hospital, Houston, Texas, USA.
Methodist Debakey Cardiovasc J. 2012 Apr-Jun;8(2):22-5. doi: 10.14797/mdcj-8-2-22.
Transcatheter aortic valve replacement (TAVR) has proven to be a viable tool for the high-surgical-risk population with severe aortic valve stenosis. Vascular access complications are not uncommon with TAVR and may increase early and late mortality. Avoiding these serious complications is the goal. With experience and careful screening, we are now able to risk-stratify patients who may be at increased risk of vascular complications. While the traditional iliofemoral access site remains the most common for TAVR, alternate access sites that have proven to be viable and safe alternatives include the transapical, direct-aortic, and subclavian techniques. TAVR teams should be familiar and comfortable with these approaches as each of them has its own advantages and weaknesses. The best option is usually one in which the procedure is tailored to the patient. The present review examines our current access planning and strategies for TAVR.
经导管主动脉瓣置换术（TAVR）已被证明是治疗严重主动脉瓣狭窄的高手术风险人群的一种可行手段。TAVR术后血管通路并发症并不少见，可能会增加早期和晚期死亡率。避免这些严重并发症是目标所在。凭借经验和仔细筛选，我们现在能够对可能有更高血管并发症风险的患者进行风险分层。虽然传统的髂股入路部位仍是TAVR最常用的部位，但已被证明是可行且安全的替代入路部位包括经心尖、直接主动脉和锁骨下技术。TAVR团队应该熟悉并熟练掌握这些方法，因为每种方法都有其自身的优缺点。最佳选择通常是根据患者情况量身定制手术的那种。本综述探讨了我们目前TAVR的入路规划和策略。
