Nature子刊:华西医院发表《经导管主动脉瓣置换术治疗二叶式主动脉瓣狭窄国际专家共识》

2022-06-24 四川大学华西医院 四川大学华西医院

作为第一份由国内团队牵头制定的心脏瓣膜病介入治疗领域的国际专家共识,为此领域中我国临床实践与学术发展的话语权打下了基础。

2022年6月20日,心血管领域著名期刊Nature Reviews Cardiology(影响因子:32. 430)在线发表了由心脏内科陈茂教授团队牵头制定的首个经导管主动脉瓣置换术治疗二叶式主动脉瓣狭窄国际专家共识。心脏内科熊恬园助理研究员为该共识的第一作者,我院心脏内科陈茂教授与英国圣托马斯医院Bernard Prendergast教授、爱尔兰国立大学戈尔韦大学医院Darren Mylotte医生为共同通讯作者,四川大学华西医院为牵头单位、第一完成单位,专家组由来自全球11个国家的介入心脏病学与心脏外科专家组成。

作为第一份由国内团队牵头制定的心脏瓣膜病介入治疗领域的国际专家共识,为此领域中我国临床实践与学术发展的话语权打下了基础。该共识的制定与发表,体现了我院心脏内科在经导管瓣膜病介入治疗领域上的国际领先学术水平,以及二叶式主动脉瓣狭窄疾病认识及治疗上的国际影响力。该共识受四川大学华西医院1·3·5计划临床孵化项目和高端人才计划项目资助。

二叶式主动脉瓣是成人最常见的先天性心脏病。二叶式主动脉瓣狭窄患者常具有椭圆形瓣环、瓣膜钙化程度高和不对称、瓣叶不等大、合并升主动脉增宽和/或横位心等解剖特殊性,上述不利因素更易造成经导管主动脉瓣置换术(TAVR)人工瓣膜植入位置不佳、瓣膜支架扩张不良等,进而可能导致瓣膜耐久性降低、残余瓣周漏、瓣环及周围结构破裂,以及升主动脉夹层等相关严重手术并发症,因此二叶式主动脉瓣狭窄被视为TAVR技术的挑战解剖类型。既往外科经验显示:在相对年轻的重度主动脉瓣狭窄老年病患中,二叶式主动脉瓣狭窄可占半数,如何改善TAVR用于二叶式主动脉瓣狭窄的治疗效果,已成为世界性的热门话题。但目前原始证据不足以形成指南推荐,许多中心面对二叶式主动脉瓣狭窄时仍有诸多具体操作上的困难。截至目前,陈茂教授团队单中心介入治疗二叶式主动脉瓣狭窄数量全球领先,并结合临床实践,长期致力于完善对二叶式主动脉瓣狭窄的认识、规范TAVR治疗二叶式主动脉瓣狭窄的流程。

本次共识制定从临床实践出发,在解剖分型、治疗方式选择、术前计划、人工瓣膜选择、术中操作、术后管理等方面做了详细的文献综述,并就15个核心问题采用规范的德尔菲法征集了国际专家组的意见,既反映了目前不同地区的临床实践差异,又形成了同行专家普遍认可的共识供全球应用。

以多数专家的选择为基准,该共识规范了TAVR评估时对二叶式主动脉瓣狭窄的分型方法、提倡发展与统一使用CT影像分型并包含TAVR结局相关的解剖因素;提出了目前仍缺乏TAVR与外科瓣膜置换的高等级随机对照试验证据,明确了在此基础上为患者选择治疗方式的不同考虑因素;阐明了术前计划应根据二叶式主动脉瓣狭窄解剖特点而着重补充分析的角度;明确了不同类型人工瓣膜选择的考量维度;对术中操作(包括球囊扩张,人工瓣膜定位、回撤、位置调整,及横位心、升主动脉病变等的应对)的要点细节进行了说明;确定了长期随访过程中需要关注的问题。共识内容涵盖了二叶式主动脉瓣狭窄诊疗的全流程,具有可操作性。

针对目前相应证据的缺失,专家组还相应地指出了解剖表型分型、临床应用结果、患者选择、手术规划、长期随访5大方面需要进一步提出研究证据的方向,提出了可供同行学者未来设计临床研究时参考的要点,有利于TAVR治疗二叶式主动脉瓣狭窄的未来发展。

原文链接:https://www.nature.com/articles/s41569-022-00734-5

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objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23182, encryptionId=1dd6231822d, topicName=主动脉瓣)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dc4b2500077, createdName=hittouch, createdTime=Sun Jun 26 02:30:05 CST 2022, time=2022-06-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1367251, encodeId=4710136e25137, content=<a href='/topic/show?id=b6222320322' target=_blank style='color:#2F92EE;'>#主动脉瓣置换术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23203, encryptionId=b6222320322, topicName=主动脉瓣置换术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0b24249, createdName=medsci246, createdTime=Sun Jun 26 02:30:05 CST 2022, time=2022-06-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1415841, 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createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/nE4GrbxL2qh8HCfQ9Aic863Ks6MQVCgNnxZib6aVhV679l2JX0YVwulK1GZ3QaOicPXvFNvZHicPicQ95qx3OH9evVw/132, createdBy=cbc15186945, createdName=fengyqf, createdTime=Sun Jun 26 02:30:05 CST 2022, time=2022-06-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1510355, encodeId=436c1510355f3, content=<a href='/topic/show?id=e9bce8254ef' target=_blank style='color:#2F92EE;'>#经导管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78254, encryptionId=e9bce8254ef, topicName=经导管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=93e010191378, createdName=lsj631, createdTime=Sun Jun 26 02:30:05 CST 2022, time=2022-06-26, status=1, ipAttribution=)]
    2022-11-10 liye789132251
  4. [GetPortalCommentsPageByObjectIdResponse(id=1974147, encodeId=674619e41479e, content=<a href='/topic/show?id=4d9d904e092' target=_blank style='color:#2F92EE;'>#西医院#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=90470, encryptionId=4d9d904e092, topicName=西医院)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d47b2500175, createdName=12498cf9m35(暂无昵称), createdTime=Tue Jan 10 12:30:05 CST 2023, time=2023-01-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2071429, encodeId=e82220e14294d, content=<a href='/topic/show?id=f576238833e' target=_blank style='color:#2F92EE;'>#二叶式主动脉瓣#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23883, encryptionId=f576238833e, topicName=二叶式主动脉瓣)], attachment=null, authenticateStatus=null, createdAvatar=, 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  5. 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encodeId=3f9b141584110, content=<a href='/topic/show?id=04812314540' target=_blank style='color:#2F92EE;'>#主动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23145, encryptionId=04812314540, topicName=主动脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=77603112682, createdName=circumcision, createdTime=Sun Jun 26 02:30:05 CST 2022, time=2022-06-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1445935, encodeId=665f14459350b, content=<a href='/topic/show?id=949e3593330' target=_blank style='color:#2F92EE;'>#华西#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=35933, encryptionId=949e3593330, topicName=华西)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/nE4GrbxL2qh8HCfQ9Aic863Ks6MQVCgNnxZib6aVhV679l2JX0YVwulK1GZ3QaOicPXvFNvZHicPicQ95qx3OH9evVw/132, createdBy=cbc15186945, createdName=fengyqf, createdTime=Sun Jun 26 02:30:05 CST 2022, time=2022-06-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1510355, encodeId=436c1510355f3, content=<a href='/topic/show?id=e9bce8254ef' target=_blank style='color:#2F92EE;'>#经导管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78254, encryptionId=e9bce8254ef, topicName=经导管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=93e010191378, createdName=lsj631, createdTime=Sun Jun 26 02:30:05 CST 2022, time=2022-06-26, status=1, ipAttribution=)]
    2023-01-04 yxch48
  6. 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  7. [GetPortalCommentsPageByObjectIdResponse(id=1974147, encodeId=674619e41479e, content=<a href='/topic/show?id=4d9d904e092' target=_blank style='color:#2F92EE;'>#西医院#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=90470, encryptionId=4d9d904e092, topicName=西医院)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d47b2500175, createdName=12498cf9m35(暂无昵称), createdTime=Tue Jan 10 12:30:05 CST 2023, time=2023-01-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2071429, encodeId=e82220e14294d, content=<a href='/topic/show?id=f576238833e' target=_blank style='color:#2F92EE;'>#二叶式主动脉瓣#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23883, encryptionId=f576238833e, topicName=二叶式主动脉瓣)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2fe4321, createdName=lifangping, createdTime=Wed Oct 12 01:30:05 CST 2022, time=2022-10-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1885833, encodeId=92ed188583382, content=<a href='/topic/show?id=3b2112532d8' target=_blank style='color:#2F92EE;'>#Nat#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12532, encryptionId=3b2112532d8, topicName=Nat)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2e6f107, createdName=liye789132251, createdTime=Thu Nov 10 22:30:05 CST 2022, time=2022-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1845931, encodeId=e9411845931d4, content=<a href='/topic/show?id=5d2f206482e' target=_blank style='color:#2F92EE;'>#专家共识#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, 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encodeId=3f9b141584110, content=<a href='/topic/show?id=04812314540' target=_blank style='color:#2F92EE;'>#主动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23145, encryptionId=04812314540, topicName=主动脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=77603112682, createdName=circumcision, createdTime=Sun Jun 26 02:30:05 CST 2022, time=2022-06-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1445935, encodeId=665f14459350b, content=<a href='/topic/show?id=949e3593330' target=_blank style='color:#2F92EE;'>#华西#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=35933, encryptionId=949e3593330, topicName=华西)], attachment=null, authenticateStatus=null, 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  8. [GetPortalCommentsPageByObjectIdResponse(id=1974147, encodeId=674619e41479e, content=<a href='/topic/show?id=4d9d904e092' target=_blank style='color:#2F92EE;'>#西医院#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=90470, encryptionId=4d9d904e092, topicName=西医院)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d47b2500175, createdName=12498cf9m35(暂无昵称), createdTime=Tue Jan 10 12:30:05 CST 2023, time=2023-01-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2071429, encodeId=e82220e14294d, content=<a href='/topic/show?id=f576238833e' target=_blank style='color:#2F92EE;'>#二叶式主动脉瓣#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23883, encryptionId=f576238833e, topicName=二叶式主动脉瓣)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2fe4321, createdName=lifangping, createdTime=Wed Oct 12 01:30:05 CST 2022, time=2022-10-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1885833, encodeId=92ed188583382, content=<a href='/topic/show?id=3b2112532d8' target=_blank style='color:#2F92EE;'>#Nat#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12532, encryptionId=3b2112532d8, topicName=Nat)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2e6f107, createdName=liye789132251, createdTime=Thu Nov 10 22:30:05 CST 2022, time=2022-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1845931, encodeId=e9411845931d4, content=<a href='/topic/show?id=5d2f206482e' target=_blank style='color:#2F92EE;'>#专家共识#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20648, encryptionId=5d2f206482e, topicName=专家共识)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=568152, createdName=snowpeakxu, createdTime=Sun May 21 06:30:05 CST 2023, time=2023-05-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1742799, encodeId=0eda1e42799c9, content=<a href='/topic/show?id=39cae96626f' target=_blank style='color:#2F92EE;'>#置换#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79662, encryptionId=39cae96626f, topicName=置换)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3a7c35056336, createdName=yxch48, createdTime=Wed Jan 04 16:30:05 CST 2023, time=2023-01-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1332837, encodeId=c0ae133283e8c, content=<a href='/topic/show?id=1dd6231822d' target=_blank style='color:#2F92EE;'>#主动脉瓣#</a>, beContent=null, 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encodeId=3f9b141584110, content=<a href='/topic/show?id=04812314540' target=_blank style='color:#2F92EE;'>#主动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23145, encryptionId=04812314540, topicName=主动脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=77603112682, createdName=circumcision, createdTime=Sun Jun 26 02:30:05 CST 2022, time=2022-06-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1445935, encodeId=665f14459350b, content=<a href='/topic/show?id=949e3593330' target=_blank style='color:#2F92EE;'>#华西#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=35933, encryptionId=949e3593330, topicName=华西)], attachment=null, authenticateStatus=null, 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  9. [GetPortalCommentsPageByObjectIdResponse(id=1974147, encodeId=674619e41479e, content=<a href='/topic/show?id=4d9d904e092' target=_blank style='color:#2F92EE;'>#西医院#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=90470, encryptionId=4d9d904e092, topicName=西医院)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d47b2500175, createdName=12498cf9m35(暂无昵称), createdTime=Tue Jan 10 12:30:05 CST 2023, time=2023-01-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2071429, encodeId=e82220e14294d, content=<a href='/topic/show?id=f576238833e' target=_blank style='color:#2F92EE;'>#二叶式主动脉瓣#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23883, encryptionId=f576238833e, topicName=二叶式主动脉瓣)], attachment=null, authenticateStatus=null, createdAvatar=, 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objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23182, encryptionId=1dd6231822d, topicName=主动脉瓣)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dc4b2500077, createdName=hittouch, createdTime=Sun Jun 26 02:30:05 CST 2022, time=2022-06-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1367251, encodeId=4710136e25137, content=<a href='/topic/show?id=b6222320322' target=_blank style='color:#2F92EE;'>#主动脉瓣置换术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23203, encryptionId=b6222320322, topicName=主动脉瓣置换术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0b24249, createdName=medsci246, createdTime=Sun Jun 26 02:30:05 CST 2022, time=2022-06-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1415841, encodeId=3f9b141584110, content=<a href='/topic/show?id=04812314540' target=_blank style='color:#2F92EE;'>#主动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23145, encryptionId=04812314540, topicName=主动脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=77603112682, createdName=circumcision, createdTime=Sun Jun 26 02:30:05 CST 2022, time=2022-06-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1445935, encodeId=665f14459350b, content=<a href='/topic/show?id=949e3593330' target=_blank style='color:#2F92EE;'>#华西#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=35933, encryptionId=949e3593330, topicName=华西)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/nE4GrbxL2qh8HCfQ9Aic863Ks6MQVCgNnxZib6aVhV679l2JX0YVwulK1GZ3QaOicPXvFNvZHicPicQ95qx3OH9evVw/132, createdBy=cbc15186945, createdName=fengyqf, createdTime=Sun Jun 26 02:30:05 CST 2022, time=2022-06-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1510355, encodeId=436c1510355f3, content=<a href='/topic/show?id=e9bce8254ef' target=_blank style='color:#2F92EE;'>#经导管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78254, encryptionId=e9bce8254ef, topicName=经导管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=93e010191378, createdName=lsj631, createdTime=Sun Jun 26 02:30:05 CST 2022, time=2022-06-26, status=1, ipAttribution=)]
    2022-06-26 fengyqf
  10. 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    2022-06-26 lsj631

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