经皮主动脉瓣植入TAVI.ppt

Transapical Approach The transapical 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 Transapical Approach Following balloon valvuloplasty, 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 Transapical Approach This 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 device Also taken into consideration is the angulation of the aorta and arch Transapical Approach In particular, a transverse or extremely unfolded ascending aorta may increase the diffi culty of delivery and positioning of the balloon-expandable devices It has been suggested that with advances in device technology and a reduction in delivery system profiles for the transarterial approach, alternative access approaches will be limited to less than 30 % of TAVR procedures Transapical Approach Contraindications to the transapical approach previous left ventricular surgery using a patch calcified pericardium severe respiratory disease Transapical Approach Others Axillary/Subclavian Approach Transaortic Approach Complications of TAVI Procedural Complications Vascular Complications Stroke and Neurological Events Coronary Occlusion Valve Malposition and Embolization Renal Impairment Conduction Disturbance Complications of TAVI Prosthesis-Related Complications Prosthesis–Patient Mismatch Paravalvular and Valvular Regurgitation Prosthetic Valve Thrombosis and Endocarditis? Question XIONGRAN 2014-11-25 QUIZ Street Avenue Street Avenue Hospital of UA Hospital of UA Hospital of UA Hospital of UA Summarize of TAVI Transcatheter aortic valve implantation (TAVI) It was introduced as an alternative treatment in pat