[ACC2012]发扬传统，开拓创新——ACC 2012主席David R. Holmes教授专访
主动脉瓣置换术的发展
经皮主动脉瓣置换术（TAVR）是一个重要的研究领域。虽然在其他国家TAVR已进入临床应用很长时间，并已有约5万例患者接受了该治疗；但在美国，我们仅有去年秋天公布的一项随机化试验。我们会在大会中讨论这些患者的长期随访结果，未来研究也将持续关注：要确定植入的装置仍然表现良好并继续表现良好的可持续性；确认我们将其应用于正确的患者组，并采用了正确的评估方法；我们还将讨论该疗法的风险获益比以及相关的新技术，如降低手术相关卒中的保护装置。
经心尖途径主动脉瓣置换术并不会被历史淘汰，因为经心尖途径已经在欧洲大型中心经过评估证实结果非常好。采用这种方法降低了卒中发生率，是一种非常有价值的方法。未来我们将有能力通过一个非常小的切口施行这个手术，并经皮封闭心尖的小切口。
<International Circulation>: I wanted to ask you about aortic stenosis and TAVR.
《国际循环》：能否向您了解一下有关主动脉瓣狭窄和TAVR方面的信息？
Dr Holmes: TAVR is a hugely important issue. Although the rest of the world has had access to it for a long time and there have been some 50000 patients treated worldwide， at least in this country， we only have the single randomized trial released this last fall. We are going to talk about the longer term follow-up of those patients here and there will be studies related to that follow-up: firstly， to make sure the device continues to perform well and continues to be durable; that we are using it in the right patient groups and being evaluated in the right way; and we will be talking about the risk-benefit ratio of it and new approaches， for example， to mitigate events like procedure-related stroke with protection devices. That is the cornerstone of the combination of STS and ACC. This meeting is all about networking between societies， the surgical societies， the imaging societies， the preventative cardiology societies. This is all about building those relationships， because that will be the thing that carries us through.
<International Circulation>:Do you think we are going to start using the direct aortic approach more frequently in the United States?
《国际循环》：您是否认为在美国将开始更多地采用直接主动脉途径？
Dr Holmes: I think we will. I think it depends on what the regulatory people do in that regard. It makes sense. There are patients who are not candidates for a transfemoral approach and for whom a direct aortic access will be a very good thing. We are using it some of the time but it will depend upon whether an investigational device exception (IDE) will be required or a new randomized trial or whatever the regulatory agencies decide. It is clearly a great opportunity.
<International Circulation>: And the transapical approach， is this a thing of the past?
《国际循环》：经心尖入径是否将被历史淘汰？
Dr Holmes: No， I don’t think so. When the trans-apical approach has been assessed in Europe at large centers like Leipzig where they have performed 2500 such transapical approaches， the results have been very good. There is a decrease in stroke in that setting and that looks like being a very useful thing. What is going to happen in the future is that we are going to have the ability to hopefully do these procedures with a very small incision and then percutaneously close that trans-apical incision. That is still a work in progress but I am very excited about that.
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