经导管主动脉瓣置换术后经皮冠状动脉介入治疗入路策略及研究现状

Strategies and research status of coronary access for percutaneous coronary intervention after transcatheter aortic valve replacement

随着经导管主动脉瓣置换术(transcatheter aortic valve replacement,TAVR)的适应证向低风险年轻患者扩大,一次或多次TAVR术后经皮冠状动脉(冠脉)介入治疗(percutaneous coronary intervention,PCI)的患者数量可能会增加,TAVR术后PCI冠脉入路已成为一个非常实际而严峻的问题。冠脉再介入存在技术困难,相对于球扩瓣而言,采用自膨瓣时TAVR术后PCI冠脉入路更具挑战。该文针对TAVR术前选择合适的瓣膜、术中实现连合缘对齐技术、术后掌握PCI冠脉入路的技巧展开讨论,以便提高术后PCI冠脉入路的成功率。

As the indications for transcatheter aortic valve replacement(TAVR)expand to low-risk young patients,the number of patients undergoing percutaneous coronary intervention(PCI)after one or more TAVR may increase.The coronary access for PCI after TAVR has become a very practical and severe problem.Coronary re-intervention poses technical difficulties,and compared to balloon expandable valve,the use of self-expanding valve is more challenging for the coronary access for PCI after TAVR.This article discusses the selection of appropriate valves before TAVR,the implementation of intraoperative commissural alignment technology,and the techniques for mastering the coronary access for PCI after TAVR,in order to improve the success rate of the coronary access for PCI after TAVR.