中国胸心血管外科临床杂志2023年4月第30卷第4期·491··指南与规范·心尖入路经导管主动脉瓣植入手术操作规范石峻'，赵元2，郭应强，TA-TAVR手术技术规范编写组■1.四川大学华西医院心脏大血管外科（成都610041）2.中南大学湘雅二医院心脏大血1管外科（长沙350122）【摘要】近年经导管主动脉瓣植入术(transcatheter aortic valve replacement,TAVR)技术快速发展。目前的指南及研究多集中于经股动脉路径主动脉瓣狭窄患者，然而对需经心尖入路的单纯主动脉瓣反流患者或其他需要经心尖入路的患者并不完全适用，影响该类患者的规范化治疗。因此，专家组在充分查阅国内外文献的基黜上，结合国内开展心尖入路经导管主动脉瓣植入术(transapical transcatheter aortic valve replacement,TA-TAVR)经验较丰富的15家中心专家的意见，提出TA-TAVR手术操作规范，旨在为临床医生提供经心尖人路的规范化诊疗原则，提高我国TA-TAVR规范化诊疗水平。【关键词】经导管主动脉瓣植入术：心尖入路：主动脉瓣反流：手术操作规范Procedure specifications for transapical transcatheter aortic valve replacementSHI Jun',ZHAO Yuan2,GUO Yingqiang',Writting Group of Procedure Specifications for TA-TAVR1.Department of Cardiowascular Surgery.West China Hospital of Sichuan University.Chengdu 610041.P.R China2.Department of Cardiowscular Surgery.Xiangya Second Hospital of Central South University.Changsha.350122.P.R ChinaComresponding author GUO Yingqiang Emaik drguoy@hotmailcom[Abstract]Transcatheter aortic valve replacement(TAVR)techniques have been rapidly developed in recentyears.Current guidelines and studies mainly focus on aortic stenosis patients treated by transfemoral approach,but theyare not completely appropriate to patients with isolated aortic regurgitation or other patients who need transapical TAVR(TA-TAVR),which affects the standardized treatment of those patients.Therefore,our team pronounced the operationalstandards for TA-TAVR,based on fully reviewing the literatures worldwide,combined with the opinions of experts from15 heart centers with rich experience in carrying out TA-TAVR in China.This standard aims to provide clinicians withstandardized diagnosis and treatment principles ofTA-TAVR and improve the quality ofTA-TAVR in China.[Key words]Transcatheter aortic valve replacement;transapical;aortic regurgitation;surgical procedures经导管主动脉瓣植人术(transcatheter aortic缺乏完整的规范与指南。现有球囊扩张瓣膜（球扩valve replacement,TAVR)是一种微创瓣膜植入手瓣)或自膨胀式瓣膜（自膨瓣）多设计为经股动脉入术，其通过导管介入技术植入人工瓣膜实现病变主路+习，部分也可通过经心尖路径释放，但其适应证动脉瓣的原位植人，恢复瓣膜功能，无需体外循环主要为AS。对于单纯主动脉瓣反流(aortic regurgi-和心脏停跳。自2002年全球首例TAVR完成以来，tation,AR)、冠状动脉（冠脉）开口低、外周血管细其发展迅速。我国自2010年完成首例植入后，每小等不适用于TF-TAVR的情况，经心尖人路经导年手术量大幅增长，已有多家公司产品获得国家食管主动脉瓣植人术(transapical transcatheter aortic品药品监督管理总局的批准上市。目前国内外指valve replacement,TA-TAVR)有较为明显的优势胸。南主要集中于主动脉瓣狭窄(aortic stenosis,AS)的截至2022年，国内TA-TAVR手术数量>4000例，适应证及操作规范，且很多研究集中在股动脉入路临床效果良好，在国内180家医院广泛开展，但目经导管主动脉瓣植人术(transfemoral transcatheter前尚无TA-TAVR相关操作规范。专家组参考国内aortic valve replacement,.TF-TAVR),心尖人路尚外TAVR的相关研究、指南和临床实践标准，检索国内外的主要电子数据库，包括PubMed、Neb ofScience、中国知网、万方数据库、欧洲心脏病学会/D0I:10.7507/1007-4848.202302011通信作者：郭应强，Emal:drguoyq@hotmail.com欧洲心胸外科协会(European Society of Cardiology/http://www.tcsurg.org
