经导管主动脉瓣置换术(TAVR)是一种治疗主动脉瓣狭窄的微创手术. As blood exits the heart, it passes through the aortic valve. In patients with aortic stenosis (one type of aortic valve disease), 这个阀门又硬又窄, and doesn't open and close as it should, making it harder for the heart to pump blood to the body. 因此，患者会感到呼吸急促、疲劳，心脏病发作的风险很高.

The only treatment for aortic valve disease is to replace the valve, which traditionally required open-heart surgery. 然而，对许多患者来说，TAVR是一种同样有效、侵入性小得多的替代方法. Instead of opening the chest to remove and replace the damaged valve, the doctor threads a catheter (a thin, flexible tube) through a blood vessel to reach the heart, then inserts a new valve inside of the faulty one, 恢复健康的血液流动. 这个过程 takes much less time than open-heart surgery, 病人恢复得更快, 更少的疼痛和疤痕.

UCSF有一个综合的 阀项目 这为心脏的四个瓣膜提供了基于导管的治疗选择.

评价

而TAVR最初是专门为心脏直视手术高风险患者开发的, it's now approved for anyone with severe aortic stenosis. To determine whether it's a good option for you, 我们的心脏专家团队将评估您的心脏健康以及整体健康. You may have all or some of the following tests as part of the evaluation:

  • 血液测试 帮助十大赌博平台排行榜评估你的健康状况. These will likely include a red blood cell count, 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, 肝脏和甲状腺正常.
  • A 胸部x光片 可以显示你的心脏的大小，并显示你的肺部是否有积液.
  • An 心电图(心电图) is a painless test to assess the heart's electrical activity. 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 经食管超声心动图 心脏成像检查是将超声探头放入食道以获得心脏腔室和瓣膜的清晰图像吗, and assess how blood flows through your heart.
  • A 心脏核磁共振 or 心脏CT扫描 provides detailed images of your blood vessels, 血液流经你的心脏, 心脏的结构和运动.
  • 右心导管 是否可以获得更多关于你的心脏跳动情况的信息. A catheter is inserted through a blood vessel and threaded into the heart, 它测量你的心脏和肺主要动脉的血压. The catheter can also measure cardiac output and blood oxygen levels.

如果你的十大赌博平台排行榜怀疑你除了主动脉狭窄之外还有冠状动脉疾病, 您还可以进行以下测试:

  • An 血管造影 提供心脏血管的图像，以便检测阻塞. 导管插入血管(通常在腹股沟区域)，并通过导线直达心脏. 造影剂(一种无害的物质，在x射线上显示得很清楚)通过导管注射, and X-ray images track the blood flow to your heart muscle.
  • A 压力测试 shows your heart's response to exertion. 十大赌博平台排行榜会给你开一些药物，让你的心脏更加努力地工作，或者要求你在跑步机上或固定自行车上锻炼，同时跟踪你的生命体征，监测你的心脏的反应.

If the evaluation indicates you would benefit from TAVR, our cardiac care team will make a treatment plan for you. Each patient's team includes a cardiologist, 心脏外科十大赌博平台排行榜, 心内科十大赌博平台排行榜, nurse practitioner and imaging specialist.

为TAVR做准备

Our team will set you up for an appointment with the UCSF 准备项目, 专门负责确保病人准备好接受预定手术的十大赌博平台排行榜, including the completion of all required testing. 准备人员将检查您的药物，以确保您有正确的使用说明, and they'll discuss your pain control options. They will share all communications and information with the TAVR team.

如何准备:

  • Talk to your doctor about your medications. 找出你在手术前几天应该或不应该服用的药物, 在这一天, 在接下来的日子里.
  • Get a dental checkup, because oral bacteria can infect the valve.
  • 制定恢复计划. 解决细节问题很重要, 比如谁会带你回家, 留在你身边, 帮你准备饭菜.

这个过程

我们在帕纳萨斯高地的加州大学旧金山分校海伦·迪勒医疗中心最先进的手术室里进行TAVR手术. 手术前, you'll have an echocardiogram (heart ultrasound), then we'll bring you to the operating room. Our team will have determined the type of anesthesia they'll use for you, as the best choice depends on certain health factors. You may be fully asleep (given general anesthesia), or you may be awake but sedated enough to be relaxed and not feel pain.

麻醉开始后, 十大赌博平台排行榜会在你的腹股沟附近做一个小切口，然后将导管插入那里的大动脉. 十大赌博平台排行榜将用它来传送一个新的瓣膜——在一个塌陷的状态下，允许它通过导管——到你的心脏. (Sometimes another artery has to be used; if that's the case for you, your doctor will let you know well in advance.)

作为手术的一部分，我们将放置一个临时起搏器以确保你的心跳保持正常. 在很多病人中, 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. We insert the device through a small incision in your wrist.

携带替代瓣膜的导管穿过血管，直到它进入受损的瓣膜. Once in place, the new valve is expanded to full size. 它把旧瓣膜的“小叶”——打开和关闭的皮瓣——推到一边，接管了调节心脏血液流动的工作. The new valve is typically made of bovine or porcine tissue; both are compatible with human tissue.

After the valve is placed, the temporary pacemaker is removed. (如果检测到心率缓慢，我们可以等到第二天再取下它.) The Sentinel device in your neck is also removed. 整个手术大约需要两到三个小时，只有心脏直视手术的一半时间.

手术后立即进行另一次超声心动图以评估新瓣膜的功能. You'll then be taken to the recovery area.

复苏

手术后立即, you'll recover in the post-anesthesia care unit, then be transferred to either our transitional care or intensive care unit, depending on the level of care you need. 病人 are encouraged to be up and walking within 24 hours. 大多数患者在十大赌博平台排行榜住一到两个晚上，在那里他们受到密切监视. 在你住院期间, your cardiac care team will conduct several follow-up tests, 包括胸部x光, 心电图和超声心动图, to ensure your heart is functioning properly.

回家之前, your team will talk with you about caring for yourself, 包括饮食等主题, 锻炼, 注意你的切口部位, 还有任何新的药物. 出院后, you'll need to have regular checkups with your primary care doctor, 当地的心脏病专家和心脏小组, 必要时. 这些检查对于确保您的新阀门一切正常并及早发现任何潜在问题非常重要.

特别是在家里康复的头几周，要注意自己的感受. 如果你有不寻常的头痛, dizziness or other concerning symptoms, call the doctor who performed your procedure immediately or dial 911.

我们建议患者在手术后至少72小时内不要开车(让切口愈合)，并在10天内避免剧烈的身体活动. TAVR recovery is much faster than recovery from open-heart surgery, and most patients can resume normal activities within two weeks.

一些病人受益于a 心脏康复计划, 由医疗保健专业人员组成的团队提供个性化的锻炼计划, 教育和支持，帮助你改善你的心脏健康和生活质量. Ask your doctor whether cardiac rehab is right for you.