<International Circulation>:  Can you summarize then， what are the complications of transcatheter aortic valve implantation?

  《国际循环》：您小结一下TAVI手术的并发症好吗？
    Prof Kuck: The most severe complication of course is a perforation of the annulus during the procedure mostly following valvuloplasty. This is almost impossible to treat; even if you have immediate surgical standby， most of these old and severely ill patients cannot be successfully treated even with open heart surgery at that point in time. So it is very important not to oversize the balloon after you perform the valvuloplasty. I believe all of the other complications today can be handled very effectively. The acute death rate should be below 0.5% if you know these complications can occur. The next most significant complication then is stroke， which can be very detrimental to the patient. We use protection devices to protect the carotid artery and the brain from emboli and this has led to significant reductions in incidence， which was in the range of 2.5-3% for stroke to less than 1% using these new devices. They are not， however， commercially available yet. Finally there is the pacemaker dependency and that depends on the valve that you implant. The rate is in the range of 5-10% for a balloon valve， the SAPIEN XT， and in the range of 10-40% for the CoreValve device because the CoreValve is more distally implanted so it is in contact with more of the atrioventricular conduction system than the SAPIEN XT device.

    Kuck教授:  瓣环穿孔是瓣膜成形术中最严重的并发症。这种情况在外科团队配合的情况下也几乎不能处理，老年且病情严重的患者即便当场开胸手术也不解决问题。因此在瓣膜成形术中避免球囊扩张过度是相当重要的。我相信其他并发症的处理会较为有效。如果充分理解并发症的发生率，手术中死亡率会降低0.5%。第二个重要的并发症是卒中，对患者的预后相当不利。术中应用血栓保护装置，保护颈动脉和大脑可以有效降低卒中率，从2.5-3%降低到1%以下。目前这种装置还未上市。起搏器依赖性取决于你所植入的瓣膜，SAPIEN XT的速率是球囊瓣膜的5-10%，而核心瓣膜速率范围在10-40%，因为它更靠近远端，较SAPIEN XT与房室传导的关系更为密切。

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