经导管主动脉瓣置换术围术期冠状动脉闭塞的评估和处理流程

Perioperative evaluation and management of coronary obstruction in transcatheter aortic valve replacement

随着经导管主动脉瓣置换术手术数量的指数增长、适应证向年轻患者扩展,更加需要关注围术期冠状动脉情况。急性冠状动脉闭塞是一种相对少见但危急生命的并发症。本文通过术前CT血管造影图像,综合考虑瓣叶弯曲长度、窦垂直高度、窦管交界处和有效窦宽度,评估冠状动脉闭塞的风险。对于冠状动脉高风险的患者,可以进行球囊预扩张、实行冠状动脉保护、BASILICA等方式进行术中评估或预防。采用多个临床案例阐述了该冠状动脉闭塞评估方法的可行性和有效性。

With the numerous increase of transcatheter aortic valve replacement and expand of indication towards younger patients,it is a great need to focus on periprocedural coronary situation.Acute coronary obstruction is a rare but devastating complication.In this context,we comprehensively considered leafl et curved length,sinus straight length,effective sinus width in sino-tubular junction to assess the coronary obstruction risk.Finally,we adopted multiple clinical cases to demonstrate the feasibility and effi cacy of this algorithm.