J Thorac Cardiovasc Surg. 2013 Jun;145(6):1444-5. doi: 10.1016/j.jtcvs.2013.02.079.
Transcatheter aortic valve replacement (TAVR) has transformed the treatment of aortic stenosis in high-risk older adults in Europe and has begun to do so in the United States. Recent Food and Drug Administration approval of the Edwards Lifesciences SAPIEN Transcatheter Heart Valve (Irvine, Calif) in inoperable and high-risk patients led to enthusiasm for widespread implementation of this technology. Experts have highlighted the central role of the multidisciplinary heart team in implementing a successful TAVR program. Other experts, such as Joseph Bavaria, have suggested that access to TAVR should be restricted to high-volume surgical aortic valve replacement centers. In our opinion, access to TAVR should not be limited to high-volume surgical centers for the following reasons. First, high surgical volume does not ensure good outcomes in complex interventional procedures. Second, centers with low or no surgical volume can have excellent interventional results. Third, new multidisciplinary heart teams have achieved excellent results in part because of the transmission of accumulated knowledge from experienced centers. Finally, in the absence of evidence suggesting that high-volume surgical centers produce superior TAVR results, therapeutic options for patients should not be limited.
经导管主动脉瓣置换术（TAVR）改变了欧洲高危老年主动脉瓣狭窄患者的治疗方式，目前也开始改变美国的治疗方式。美国食品和药物管理局（FDA）最近批准了爱德华兹生命科学公司的 Sapien 经导管心脏瓣膜（加利福尼亚州欧文）在无法手术和高危患者中的应用，这引发了人们对广泛应用这项技术的热情。专家强调了多学科心脏团队在实施成功的 TAVR 项目中的核心作用。其他专家，如约瑟夫·巴伐利亚（Joseph Bavaria），则认为 TAVR 的应用应该限于高容量的外科主动脉瓣置换中心。在我们看来，不应该将 TAVR 的应用限于高容量的外科中心，原因如下。首先，高手术量并不能确保复杂介入手术的良好结果。其次，手术量低或没有的中心也可以取得优异的介入结果。第三，新的多学科心脏团队之所以能够取得优异的结果，部分原因是经验丰富的中心积累的知识的传递。最后，在没有证据表明高容量外科中心能产生更好的 TAVR 结果的情况下，不应限制患者的治疗选择。
