什么是TAVR心臟手術(shù)?

什么是TAVR心臟手術(shù)?

WHEN THE ROLLING STONES announced the postponement of their 2019 tour because Mick Jagger was having health problems, fans were understandably disappointed and a little worried. Jagger is, after all, 75 years old, and when it became apparent that he was having heart surgery, the concern rose – but not for Dr. Joseph Cleveland. A heart surgeon and professor of surgery at the University of Colorado Anschutz Medical Campus, Cleveland knew that Jagger would be back prancing the stage sooner than anyone knew. “I told people, don’t sell your tickets. He will be back in the fall,” Cleveland says.

當(dāng)滾石樂隊(duì)宣布由于米克·賈格爾的健康問題而推遲2019年巡演時(shí)，歌迷們感到失望和有點(diǎn)擔(dān)心。賈格爾畢竟已經(jīng)75歲了，當(dāng)?shù)弥鲂呐K手術(shù)的消息時(shí)，人們開始擔(dān)心了——但約瑟夫·克利夫蘭醫(yī)生卻沒有。作為一名心臟外科醫(yī)生和科羅拉多大學(xué)安舒茨醫(yī)學(xué)校區(qū)的外科教授，克利夫蘭知道賈格爾會(huì)比任何人都知道的更早重返舞臺(tái)。“我告訴人們，不要賣票。他將在秋天回來，”克利夫蘭說。

In fact, Jagger and his bandmates will be back even sooner than that. The Stones rescheduled their Denver concert for August 10 – just four months after Jagger had his aortic valve replaced through a procedure known as transcatheter aortic valve replacement, or TAVR, surgery. Heart surgeons like Cleveland aren’t surprised. The TAVR procedure has helped transform the treatment of a potentially fatal disease, aortic stenosis.

事實(shí)上，賈格爾和他的樂隊(duì)成員會(huì)比這更早回來。滾石樂隊(duì)將他們?cè)诘し鸬难莩獣?huì)改在8月10日舉行，而就在4個(gè)月前，賈格爾剛剛接受了主動(dòng)脈瓣置換術(shù)，即經(jīng)導(dǎo)管主動(dòng)脈瓣置換術(shù)(TAVR)。像克利夫蘭這樣的心臟外科醫(yī)生并不感到驚訝。TAVR手術(shù)幫助改變了一種潛在致命疾病的治療方法。

Symptoms of aortic stenosis include:

主動(dòng)脈狹窄的癥狀包括：

· Chest discomfort or pain that may get worse with activity and reach into the arm, neck or jaw

胸部不適或疼痛，且可能因活動(dòng)而嚴(yán)重，這種疼痛可能延伸到到手臂、頸部或下巴

· Cough, possibly bloody

可能咳血

· Breathing problems when exercising

運(yùn)動(dòng)時(shí)出現(xiàn)呼吸問題

· Becoming easily tired

易困

· Feeling the heart beat (palpitations)

感覺心跳(心悸)

· Fainting, weakness or dizziness with activity

暈厥，虛弱或活動(dòng)引起的頭暈

Without treatment, aortic stenosis can lead to heart attack, stroke and death.

如果不進(jìn)行治療，主動(dòng)脈狹窄可能導(dǎo)致心臟病發(fā)作、中風(fēng)和死亡。

What Is the TAVR Procedure?

TAVR手術(shù)程序是什么?

As recently as about a half-dozen years ago, the only way to repair a stenotic aortic artery was through open-heart surgery. This surgery is very successful for otherwise healthy individuals, but aortic stenosis is typically a disease that affects older patients in their 70s and 80s who have other health concerns. Open-heart surgery is a big and taxing operation, involving the cracking of the rib cage to expose the heart muscle and putting the patient on a heart-lung machine to keep him or her alive while the heart is stopped for repair. It’s more than many elderly patients can handle. For them, there was no treatment for the disease.

就在大約6年前，修復(fù)狹窄的主動(dòng)脈的唯一方法還是通過開胸手術(shù)。這種手術(shù)對(duì)于健康的人來說非常成功，但是主動(dòng)脈狹窄通常是一種影響70多歲和80多歲有其他健康問題的老年患者的疾病。開胸手術(shù)是一項(xiàng)龐大而費(fèi)力的手術(shù)，包括打開胸腔露出心肌，讓病人在心臟停止時(shí)用心肺機(jī)維持生命來修復(fù)。這超出了許多老年病人的承受能力。對(duì)他們來說，這種疾病沒有治療方法。

In 2012, however, the Food and Drug Administration approved TAVR for these high-risk patients. This minimally invasive procedure replaces open-heart surgery. TAVR surgery is similar to the way interventional cardiologists install a stent into a blocked artery. The surgeon threads a catheter through an artery in the groin, usually the femoral artery – or occasionally through an artery in the chest, if the leg arteries aren’t suitable – to the heart and aortic valve. Various surgical tools are then threaded through the catheter to the site of the damaged valve. But instead of surgically removing the old valve, which is the procedure in open-heart repair, TAVR squeezes a collapsed replacement valve into the damaged valve’s place. The new valve is then expanded to push the old valve to the sides and take over, better regulating blood flow.

然而，在2012年，美國食品和藥物管理局(Food and Drug Administration)批準(zhǔn)將TAVR用于這些高危患者。這種微創(chuàng)手術(shù)取代了開胸手術(shù)。TAVR手術(shù)類似于將支架植入被阻塞動(dòng)脈的方法。外科醫(yī)生將導(dǎo)管穿過腹股溝的動(dòng)脈，通常是股動(dòng)脈——如果腿部動(dòng)脈不適合的話，偶爾也會(huì)穿過胸部的動(dòng)脈——到達(dá)心臟和主動(dòng)脈瓣。然后將各種手術(shù)工具通過導(dǎo)管穿入受損瓣膜的位置。但是，TAVR并沒有像開胸修復(fù)那樣通過外科手術(shù)移除舊瓣膜，而是將一個(gè)塌陷的替換瓣膜擠壓到受損瓣膜的位置。然后，新的瓣膜被擴(kuò)大，將舊的瓣膜推到兩側(cè)并接管，從而更好地調(diào)節(jié)血液流動(dòng)。