TAVI是近十年来介入心脏病学领域的一项令人鼓舞的技术。2002年，来自法国的Alain G. Cribier教授开展了这一技术。十余年来，全球各国纷纷开展了TAVI术，累积约5万例。2010年，复旦大学中山医院率先开展了我国第一例TAVI手术。随后，阜外心血管病医院等单位纷纷开展。
一项新技术在国内的展开，一定需要大量学习国外的经验，而且TAVI技术本身也在日新月异地发展。在刚刚闭幕的CIT2013大会上，不仅实况转播了纽约长老会医院的TAVI手术，报道了非常精彩的国外专家学术报告，还有中国TvT联盟的相关活动。在这个背景下，《门诊》杂志特别采访了经导管主动脉瓣植入的第一人——来自法国的心血管病专家Alain G. Cribier教授，请他来跟我们谈论一下有关这方面的详细情况。
CLINIC: What is the basic concept of TAVI (Transcatheter Aortic Valve of Implantation)?
Alain G. Cribier:The fact is that I developed the “Balloon Aortic Valve” which uses the balloon to dilate the valve. The result of balloon aortic valve replacement is very good. However, the problem is that we try to find something that maintains the valve open without closing again. The idea is that we put the plastic stent inside the valve within the valvular structure to improve the result of TAVI. This is very smart idea that we replace the balloon valve with stent valve. This concept also applies to the pulmonary artery procedure.
《门诊》：首先，请问关于经导管主动脉瓣植入，它的基本原理是什么？
Alain G. Cribier：事实上，我是第一个运用球囊植入主动脉瓣，即利用球囊扩张主动脉瓣。事实证明，利用球囊代替主动脉瓣的结果是非常好的。但是我们主要想解决的问题是，找到一个可以持续地将主动脉瓣打开而不会再次关闭的物件。由此我们产生了一个想法，将一个塑料的支架放入脉瓣，从而提高经导管主动脉瓣的效果。这个原理同样适用于肺动脉的操作过程。
CLINIC: How to apply TAVI procedure in the actual clinical situations?
Alain G. Cribier:We have increased the number of patients, and it is an excellent technique which can spiritually improve the quality of life. Everyone is really interested in this technique, but the problem is that we limit the indication that the patients who are not good candidates for the surgery. For example, they are too old, they have immobilities, and the risk of surgery is pretty high.
《门诊》：如何将经导管主动脉瓣植入的操作运用到现实的临床中？
Alain G. Cribier：随着患者数量持续的增加，我们发现这是一个能够提高患者生活质量极好的技术，社会各界对于此项技术也都相当感兴趣。但是问题在于，临床医师必须限制此项操作的适应证，目前通常只选择那些不适合外科手术的患者。例如年龄太大、四肢瘫痪以及手术具有高风险的患者。
CLINIC: What is the scope of TAVI?
Alain G. Cribier:Today the scope of TAVI is that patient has high risk for surgery or has contraindications for the surgery. The decision has to be taken by the heart team which includes the cardiologist, the surgeon and other staffs, and they will get together to discuss each case individually. The most important indication is that we can use “Valvein-Valve” technique for the aortic regurgitation.
《门诊》：在应用过程中，经导管主动脉瓣植入的具体适用范围是什么？
Alain G. Cribier：目前，经导管主动脉瓣植入主要适用于手术具有高风险或者因为某种病症不可以进行手术的患者。但是最终的决定取决于包括心脏专家、外科医生和其他相关人员在内的整个心脏团队。他们会一起讨论每个患者的情况，最终综合评定其是否可以进行经导管主动脉瓣植入。最重要的一点就是，对于诸如主动脉返流的患者，我们可以使用“瓣中瓣”的技术。
CLINIC: What data or information do you need to collect in order to successfully finish this procedure?
Alain G. Cribier:The valve should be confirmed to be placed in the right place, but in the pulmonic arteries or ventricular blocks. We want to have as less as possible leaking on the site. We do Echogram and Angiogram to check immediately after the procedure. In the follow-up, we mainly control by Echogram,and we also check the effect on the left ventricular performance.
《门诊》：为了顺利完成经导管主动脉瓣植入，专家们需要收集怎样的数据以及何种相关的信息？
Alain G. Cribier：首先我们应该检查确定瓣膜植入在正确的位置上，不在肺动脉，也不在心室阻滞处。我们希望尽量少的液体从伤口处渗出。在操作流程结束之后，我们立刻做超声影像和血管造影去检测主动脉瓣植入的情况。在接下来的跟踪和检查中，我们仍然主要依靠超声影像所显示的结果，同时我们也会检测此操作对于左心室的影响。
CLINIC : What are the most? significant complications for TAVI?
Alain G. Cribier:?Vascular complications mainly occur in the entry site since the size of needle selected.The very large size 24 or 26 Fr is about 9 mm to be used in U.S., but only 16 or 18 Fr is used in Europe.Comparing to the U.S., Europe select much smaller size to avoid complications. Severe vascular complications will affect the survival rate of patients, such as stroke embolization and occlusion from the arteries. We try to improve those complications by putting the filter inside the valve, and we are catching the thrombus to make sure that they will not immigrate from the valves to the brain. One of other complications may affect cardiac pacemaker since the device is implanted relatively low inside the ventricle so that it could contact lower bottom of stent with septum where is his-bundle located.
《门诊》：在操作过程中，经导管主动脉瓣植入最明显的并发症是什么？
Alain G. Cribier：血管并发症主要发生在操作进出口处，主要原因是由于所选的针头尺寸过大。美国选用的是24或者26Fr大概是9毫米左右的针头，而欧洲大多采用16或18Fr比较小一点的尺寸。这样可以大大避免血管并发症的发生。严重的血管并发症中风栓塞和动脉血管堵塞甚至会影响患者的存活率。我们通过在瓣膜里放入一个过滤器来尽量改善这些并发症，这样我们就可以采集到一些小的成分而形成的血栓，从而确保血栓不会从瓣膜转移到大脑。
还有一个可能影响心脏起搏器的重要并发症，这个并发症主要是由于所用仪器被植入心室的位置相对比较低，以至于接触到了支架的底部和心室的隔膜。
CLINIC: How long will it take for the whole procedure?
Alain G. Cribier:Normally it will take 45 minutes to 1 hour, and we use local anesthesia instead of general anesthesia, so the patient will not need to be intubated. It is a standard procedure, and it is simple,fast and easy. After two to three days, the patient can be discharged.
《门诊》：整个经导管主动脉瓣植入操作过程持续时间大概要多久？
Alain G. Cribier：通常情况下整个操作过程大概在45分钟到一个小时左右，我们一般采用的是局部麻醉而不是全身麻醉，这样患者基本上还是清醒的。这是一个比较标准的操作流程，而且简单、快速、轻松。约2至3天后，经检查若无其他问题，患者就可以出院了。
个人简介
Alain G. Cribier
法国查尔斯尼克利医院心脏科
法国查尔斯尼克利医院心脏专家，任罗本大学教授，美国心脏病学学会会员，经导管主动脉瓣植入第一人。
