Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure for treating aortic valve stenosis. 当血液流出心脏时,它会经过主动脉瓣. 主动脉狭窄患者(主动脉瓣病变的一种), 阀门又硬又窄, 不能正常地打开和关闭, 使心脏更难向身体泵血. As a result, patients feel short of breath and fatigued, and are at high risk for a heart attack.

主动脉瓣疾病的唯一治疗方法就是更换瓣膜, 哪种传统上需要开胸手术. For many patients, however, TAVR is an equally effective, much less invasive alternative. 而不是打开胸腔拆卸和更换损坏的阀门, 6686体育把导管(细的)穿线穿好, 软管)通过血管到达心脏, 然后在故障的阀门里面插入一个新的阀门, 恢复健康的血液流动. 这种手术比开胸手术时间短得多, 而且病人恢复得更快, 更少的痛苦和疤痕.

UCSF有一个全面的 阀项目 这为所有四个心脏瓣膜提供了导管治疗方案.

评价

While TAVR was originally developed specifically for patients at high risk with open-heart surgery, 它现在被批准用于任何严重的主动脉狭窄患者. 来决定这对你来说是不是一个好的选择, our team of heart specialists will evaluate your heart health as well as your overall health. 您可能需要进行以下全部或部分测试作为评估的一部分:

  • 血液测试 帮助6686体育评估你的健康状况. 这些可能包括红细胞计数, which indicates how much oxygen is being delivered to your body's cells; electrolyte levels, which can be disturbed by an underlying illness; and tests to measure substances in the bloodstream that reflect how well your kidneys, 肝脏和甲状腺都在工作.
  • A 胸部x光片 can show the size of your heart and reveal whether you have fluid buildup in your lungs.
  • An 心电图(心电图) 无痛测试是用来评估心电活动的吗. 电极被贴在你的胸部, arms and legs to record and measure the signals that cause your heart to beat.
  • A 技术超声心动图(TEE) is a heart-imaging test in which an ultrasound probe is put into your esophagus in order to obtain clear images of your heart's chambers and valves, 并评估血液在心脏中的流动情况.
  • A 心脏核磁共振 or 心脏电脑断层扫描 提供血管的详细图像, 血液流经心脏, 还有你的心脏的结构和运动.
  • 右心导管术 may be performed to obtain more information about how well your heart is pumping. 导管通过血管插入心脏, where it measures the blood pressure in your heart and in the main arteries of your lungs. 该导管还可以测量心排血量和血氧水平.

If your doctor suspects that you have coronary artery disease in addition to aortic stenosis, 你也可以进行以下测试:

  • An 血管造影 provides images of the heart's blood vessels, so that blockages can be detected. A catheter is inserted into a blood vessel (usually in the groin area) and threaded up to the heart. A contrast dye (a harmless substance that shows up well on X-rays) is injected through the catheter, x光图像跟踪流向心肌的血液.
  • A 压力测试 显示你的心脏对用力的反应. You'll either be given medication that makes your heart work extra hard or asked to 锻炼 (on a treadmill or stationary bike) while your vital signs are tracked and your heart's response is monitored.

如果评估显示你能从TAVR中获益, 我们的心脏护理团队会为您制定治疗方案. 每个病人的团队都包括一名心脏病专家, 心脏外科6686体育, 心内科6686体育, 执业护士和影像专家.

准备接受TAVR

我们的团队会为你安排和UCSF的会面 准备项目, which is dedicated to ensuring that patients are ready for their scheduled procedures, 包括完成所有需要的测试. The Prepare staff will review your medications to be certain you have the correct instructions regarding their use, 他们会讨论你的疼痛控制方案. 他们将与TAVR团队共享所有通信和信息.

如何准备:

  • 和你的6686体育谈谈你的药物. Find out which you should or shouldn't take on the days leading up to your procedure, 这一天本身, 在接下来的日子里.
  • 做一次牙科检查,因为口腔细菌会感染瓣膜.
  • 制定恢复计划. 解决细节问题很重要, 比如谁会带你回家, 和你在一起, 帮你准备饭菜.

这个过程

We perform TAVR procedures in a state-of-the-art operating room at the UCSF Helen Diller Medical Center at Parnassus Heights. 之前的程序, 你要做个超声心动图。, 然后我们会带你去手术室. 我们的团队会决定给你用哪种麻醉, 因为最佳选择取决于某些健康因素. 你可能处于完全睡眠状态(全身麻醉), 或者你可能醒着,但镇静得足够放松,感觉不到疼痛.

麻醉开始后, the doctor will make a small incision near your groin and insert the catheter into the major artery there. The doctor will use this to convey a new valve – in a collapsed state that allows it to pass through the catheter – to your heart. (Sometimes another artery has to be used; if that's the case for you, 你的6686体育会提前告诉你.)

As part of the procedure, we will place a temporary pacemaker to ensure your heartbeats stay regular. 在许多患者, we also insert a Sentinel filtration device into a blood vessel in your neck; this lowers the risk of stroke by preventing tiny bits of plaque that might be dislodged during the procedure from traveling to your brain. 我们通过你手腕上的一个小切口植入这个装置.

The catheter carrying the replacement valve is threaded through the blood vessel until it's inside your damaged valve. 一旦安装到位,新阀门就会扩展到全通径. It pushes aside the "leaflets" of the old valve – the flaps that open and close – and takes over the job of regulating blood flow from the heart. The new valve is typically made of bovine or porcine tissue; both are compatible with human tissue.

放置瓣膜后,移除临时起搏器. (If a slow heart rate is detected, we may wait until the following day to remove it.)你脖子上的哨兵装置也被移除. The whole operation takes about two to three hours – half as long as open-heart surgery.

Another echocardiogram is performed immediately after the procedure to assess function of the new valve. 然后你会被带到恢复区.

复苏

手术之后, 你会在麻醉后护理病房恢复的, 然后转到我们的过渡护理病房或重症监护室, 这取决于你需要的护理水平. 鼓励患者在24小时内起床行走. Most patients spend one to two nights in the hospital, where they are closely monitored. 住院期间, 你的心脏护理团队会进行几项后续检查, 包括胸透, 心电图和超声心动图, 以确保你的心脏正常运作.

回家之前, 你的团队会和你讨论如何照顾好自己, 涵盖的主题,如饮食, 锻炼, 注意切口部位, 任何新的药物. 出院后, 你需要和你的初级保健6686体育定期进行检查, 当地心脏病专家和心脏团队, 必要时. These checkups are important for ensuring all is well with your new valve and detecting any potential problems early.

Particularly during the first weeks of recovery at home, be mindful of how you're feeling. 如果你有不寻常的头痛, 头晕或其他有关症状, 请立即致电为您进行手术的6686体育或拨打911.

We advise patients not to drive for at least 72 hours after the procedure (to allow the incisions to heal) and to avoid strenuous physical activity for 10 days. TAVR的恢复比开胸手术的恢复快得多, 大多数患者可以在两周内恢复正常活动.

有些病人受益于 心脏康复计划, in which a team of health care professionals provides an individualized 锻炼 plan, education and support to help you improve your heart health and quality of life. 询问你的6686体育心脏康复是否适合你.