什么是TAVR心脏手术?
什么是TAVR心脏手术?
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.
当滚石乐队宣布由于米克·贾格尔的健康问题而推迟2019年巡演时，歌迷们感到失望和有点担心。贾格尔毕竟已经75岁了，当得知他要做心脏手术的消息时，人们开始担心了——但约瑟夫·克利夫兰医生却没有。作为一名心脏外科医生和科罗拉多大学安舒茨医学校区的外科教授，克利夫兰知道贾格尔会比任何人都知道的更早重返舞台。“我告诉人们，不要卖票。他将在秋天回来，”克利夫兰说。
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.
事实上，贾格尔和他的乐队成员会比这更早回来。滚石乐队将他们在丹佛的演唱会改在8月10日举行，而就在4个月前，贾格尔刚刚接受了主动脉瓣置换术，即经导管主动脉瓣置换术(TAVR)。像克利夫兰这样的心脏外科医生并不感到惊讶。TAVR手术帮助改变了一种潜在致命疾病的治疗方法。
Symptoms of aortic stenosis include:
主动脉狭窄的症状包括：
· Chest discomfort or pain that may get worse with activity and reach into the arm, neck or jaw
胸部不适或疼痛，且可能因活动而严重，这种疼痛可能延伸到到手臂、颈部或下巴
· Cough, possibly bloody
可能咳血
· Breathing problems when exercising
运动时出现呼吸问题
· Becoming easily tired
易困
· Feeling the heart beat (palpitations)
感觉心跳(心悸)
· Fainting, weakness or dizziness with activity
晕厥，虚弱或活动引起的头晕
Without treatment, aortic stenosis can lead to heart attack, stroke and death.
如果不进行治疗，主动脉狭窄可能导致心脏病发作、中风和死亡。
What Is the TAVR Procedure?
TAVR手术程序是什么?
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.
就在大约6年前，修复狭窄的主动脉的唯一方法还是通过开胸手术。这种手术对于健康的人来说非常成功，但是主动脉狭窄通常是一种影响70多岁和80多岁有其他健康问题的老年患者的疾病。开胸手术是一项庞大而费力的手术，包括打开胸腔露出心肌，让病人在心脏停止时用心肺机维持生命来修复。这超出了许多老年病人的承受能力。对他们来说，这种疾病没有治疗方法。
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，美国食品和药物管理局(Food and Drug Administration)批准将TAVR用于这些高危患者。这种微创手术取代了开胸手术。TAVR手术类似于将支架植入被阻塞动脉的方法。外科医生将导管穿过腹股沟的动脉，通常是股动脉——如果腿部动脉不适合的话，偶尔也会穿过胸部的动脉——到达心脏和主动脉瓣。然后将各种手术工具通过导管穿入受损瓣膜的位置。但是，TAVR并没有像开胸修复那样通过外科手术移除旧瓣膜，而是将一个塌陷的替换瓣膜挤压到受损瓣膜的位置。然后，新的瓣膜被扩大，将旧的瓣膜推到两侧并接管，从而更好地调节血液流动。
