经导管主动脉瓣膜植入(TAVI)是一项近年发展起来用于无法耐受常规开胸手术治疗的患主动脉瓣膜狭窄患者的新技术。除了需要选择合适的患者外, 手术径路的选择也是TAVI能否获得成功的关键。目前采用的TAVI手术径路包括:顺行法、逆行法、经心尖法、经锁骨下动脉法及直接经主动脉法, 逆行法是目前最常采用的手术径路。采取何种手术径路需根据患者血管及主动脉根部的条件来合理选择。本文综述了这几种手术径路选择的标准、手术并发症, 常规手术方法及最新临床资料统计结果, 以有利于该项技术在我国开展。
TAVI is a new technology for the patients who cannot receive the routine surgical aortic valve replacement under cardiopulmonary bypass.Vascular access is also a key point to success of TAVI,beside the selection of indication.Presently,the available vascular access mainly includes:antegrade approach,retrograde approach,transapical approach,trans-subclavian approach,and direct trans-aortic approach.Trans-femoral approach is the dominant TAVI route; however,each of them has their advantages and disadvantages.Selection of vascular approach depends on the conditions of patient’s arteries and aortic root.In this study,selective principle,complications,surgical methods and the latest clinical research of each vascular approach are reviewed,in order to develop this technology in China.
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