那些患者适合行血管内瓣膜植入术PPT.ppt

那些患者适合行血管内瓣膜植入术?;;经导管主动脉瓣植入术;经导管主动脉瓣植入术临床经验;那些患者适合行经导管ＡＶＲ?;We don’t turn down anyone! ;“无法手术” 是指 …;;;;问题;单纯主动脉瓣置换手术死亡率 -STS Database;STS 单纯根据年龄的ＡＶＲ死亡风险 预测;主动脉瓣手术风险预测方法;;风险预测方法中存在的问题;危险因素没有纳入到风险计算法;我们如何评估风险 ?;AVR的风险;;AVR的风险; 由于多个生理系统机能下降导致对外界应激因子的抵抗能力及储备下降的生物学综合征，从而使机体对不良事件的耐受能力下降。;衰弱的指标;副作用 ( Death or Institutionalization) 根据 “虚弱指数”;临床虚弱指数 (1-7);AVR风险;PARTNER IDE 试验;PARTNER 经导管AVR试验 Dallas Screening Log2006．１２-2008．１０  n=292;经导管主动脉瓣植入术Dallas - August, 2006- October, 2008;;;总结;Who is a Candidate for an Endovascular Valve?;;Transcatheter Aortic Valve Implantation;Transcatheter Aortic ValvesClinical Experience;Who Are Suitable Candidates for Transcatheter AVR ?;Questions;Questions;We don’t turn down anyone! ;“Inoperable” is in the …;;;;Questions;Isolated Aortic Valve ReplacementOperative Mortality-STS Database;STS Predicted Risk of Mortality with AVR Based on Age Alone;Aortic Valve SurgeryPredictive Risk Algorithms;;Problems with Risk Algorithms;Risk Factors Not Included in Risk Algorithms;How Do We Evaluate Risk ?;Risk of AVR;;Risk of AVR; A biologic syndrome of decreased reserve and resistance to stressors, resulting from cumulative declines across multiple physiologic systems, and causing vulnerability to adverse outcomes.;Frailty Indices;Adverse Outcomes ( Death or Institutionalization) Based on “Fraility Index”;Clinical Frailty Index (1-7);Risk of AVR;The PARTNER IDE Trial;PARTNER Transcatheter AVR TrialDallas Screening LogAugust 2006-October 2008  n=292;Transcatheter Aortic ValveDallas - August, 2006- October, 2008;;;Summary