Braxton John H, Rasmussen Kelly S, Shah Milind S
Structural Heart Services, Marshfield Clinic, Saint Joseph Hospital, 1000 North Oak Avenue, Section 2C2, Marshfield, WI 54449, USA.
Structural Heart Services, Department of Cardiology, Marshfield Clinic, Saint Joseph Hospital, 1000 North Oak Avenue, Section 2C2, Marshfield, WI 54449, USA.
Surg Clin North Am. 2017 Aug;97(4):899-921. doi: 10.1016/j.suc.2017.03.011.
Patients with inoperable, high-risk, and intermediate-risk aortic stenosis can now be treated with transcatheter aortic valve replacement. Centers for Medicare and Medicaid Services and the Food and Drug Administration selectively choose centers based on experience and require a collaborative, multidisciplinary team approach in the treatment and decision making for these patients. The work-up has been streamlined. Gated multislice computed tomography angiogram has emerged as the gold standard for assessment of valve anatomy and sizing of the transcatheter heart valve. Assessment of risk has evolved to include a more comprehensive functional and frailty evaluation. Long term-results are needed before the expansion of transcatheter aortic valve replacement into the low-risk category.
无法进行手术的高危和中危主动脉瓣狭窄患者现在可以接受经导管主动脉瓣置换术治疗。医疗保险和医疗补助服务中心以及食品药品监督管理局根据经验有选择地挑选治疗中心,并要求在对这些患者的治疗和决策过程中采用协作性的多学科团队方法。检查流程已得到简化。门控多层计算机断层扫描血管造影已成为评估瓣膜解剖结构和经导管心脏瓣膜尺寸的金标准。风险评估已发展为包括更全面的功能和衰弱评估。在将经导管主动脉瓣置换术扩展至低风险类别之前,需要获得长期结果。