Alain G. Cribier教授  从概念到临床TAVI治疗之父、法国Hopital Charles Nicolle医院心内科主任

　　<International Circulation>: As a pioneer in TAVI， what can cardiologists learn from TAVI’s success in treatment of structural heart disease?

　　Prof. Cribier: Well actuallythey know a lot， first of all TAVI does correspond to clinical leads so this is extremely important and as you know if you take the whole population of patients with aortic stenosis you know that when there symptomsare very high for like 80% at 2 years nothing could be done until the moment we started with valvuloplasty and then it became which just a way to improve their results withvalvuloplastyso that we learned that something can be done for this very significant population of people who have the symptoms， who have the disease， who are really life threatened and for whom nothing could be done until now.  So we have a way to clinically improve their life expectancy and also their quality of life so I am very proud that this technique is really spreading because of this reason. We are saving and improving life for a lot of patients.

　　《国际循环》: 作为TAVI的先驱，您认为TAVI的成功为心内科医生经皮治疗结构性心脏病带来了哪些启示？

　　Cribier教授：实际上临床医生对TAVI具有一定的了解，首先TAVI影响临床结局，因此极为重要。正如你所知道的，对伴有主动脉瓣狭窄患者而言，如果其发病两年时症状发生率高达80%，此时除了开始行瓣膜成形术我们别无选择。瓣膜成形术成为我们改善这些患者临床结局的唯一途径。因此，我们已经知道对面临生命威胁的、有症状的主动脉瓣狭窄患者我们还是可以做些什么的。我们已经拥有了能够提高其预期寿命及生活治疗的方法。我非常自豪的是，该项技术正在不断被推广。我们正在挽救很多患者的生命并改善其生活。

　　<International Circulation>: So what is the next stage for TAVI?  What problems with the procedure remain to be solved?

　　Prof. Cribier: Well today I think we have solved a number of issues which we are breaking down from where we started.  If you take the history of the problem， the technique was first proposed by us by using a kind of sophisticated approach which is using the transeptal approach on one hand， so it was good because the devices we were using were very precise so we had no vascular complication at all.  Then we moved to the transfemoral approach and transapical approach with the Edwards valve. On the other hand with CoreValve we started with transfemoral and the subclavian and some problems came from these new approaches which were resolved and very good and able to be spread in the world because it was the easiest way， but certainly we understood that devices were coming through the advanced from the femoral artery which were associated with a number of cardiovascular complications.  The first that we detected with this technology is the number of cardiovascular complications related to the approach - bleeding and also life threatening complications.  And then came some other complications like for example stroke or paravalvularaortic insufficiency or atrioventricular block， need for pacemaker， and so on.  So we put all of that together and the companies involved， Edwards and Medtronic worked a lot to improve the device， improve the technology， and improve the screening of patients to make sure that we wilhave an improvement in these issues and we got it.  I think we are on a good way to resolve these problems.

　　《国际循环》：那么TAVI下一步的发展方向是什么？其实施过程仍有哪些问题需要解决？

　　Cribier教授：我认为我们已经解决了该技术最初面临的一些问题。回顾这项技术的发展史，一方面你可以发现，我们最初提出的这项技术应用的是一种复杂方法即经中隔途径。这种方法非常好，那时我们所用的设备非常精确，因而不会发生血管并发症。随着Edwards瓣膜的问世，我们换用了经股动脉途径及经心尖途径。另一方面，随着CoreValve的出现，我们开始应用经股动脉途径及锁骨下途径，这些在世界范围内被推广应用的好的新方法带来了一些问题。因为其是最简单的途径，但我们知道设备顺着股动脉前行会引发心血管并发症。首先，我们发现的是这项技术会引发与手术途径有关的心血管并发症--出血及其他威胁生命的并发症。然后，还有一些其他并发症，例如卒中、主动脉瓣关闭不全、房室传导阻滞、需要心脏起搏器等。因此，我们综合考虑上述情况，在Edwards 及美敦力公司的参与下，作了大量的工作以改善设备，提高技术，增强对患者的筛选，从而确保我们能够改善这些问题。我们也确实做到了。我认为，我们正在朝着好的方向逐步解决这些问题。

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