主席

主持人

特邀嘉宾

Course Director

讨论嘉宾

学习目标： 1. 掌握TAVR人工瓣膜衰败后的临床决策路径： 明确二次微创介入（Redo TAVR）与外科直视手术（Explant）的适用指征、风险获益比及个体化优选策略。 Master the Clinical Decision-Making Pathway for TAVR Bioprosthetic Valve Failure: Clarify the specific indications, risk-benefit ratios, and individualized optimal strategies when choosing between transcatheter re-intervention (Redo TAVR) and surgical explantation (Explant). 2. 熟悉Redo TAVR术前多模态影像学评估核心： 深入理解基于CT的精细化解剖特征分析，特别是如何精准评估冠脉阻塞风险、瓣膜重叠空间（THV-in-THV）及安全手术路径。 Familiarize with the Core of Preoperative Multimodal Imaging Assessment for Redo TAVR: Deeply understand CT-based refined anatomical analysis, particularly the precise evaluation of coronary obstruction risks, transcatheter heart valve overlapping space (THV-in-THV), and safe procedural access. 3. 精通Redo TAVR的瓣膜策略与严重并发症防范： 掌握球扩瓣在再介入中的优势、尺寸匹配与精细化定位策略；熟练掌握电外科技术（如人工瓣叶切开术等）作为防范冠脉阻塞致命并发症的规范化应用。 Excel in Valve Strategies and Severe Complication Mitigation in Redo TAVR: Master the clinical advantages, sizing matrices, and precise positioning strategies of balloon-expandable valves in re-interventions; proficiently adopt the standardized application of electrosurgical techniques (e.g., bioprosthetic leaflet laceration) as a critical line of defense against fatal coronary obstruction.

讨论建议 讨论定位：建议围绕“高危Redo TAVR的术前精准决策、瓣膜与尺寸选择艺术、以及致命并发症的电外科防范”展开。重点探讨Redo TAVR vs Explant的实际临床抉择、术前CT解剖特征（如VTC距离、原有瓣膜架高度）对风险的预测、球扩瓣在再介入中的应用技巧，以及电外科技术（如BASILICA等）在保护生命线（冠脉）中的实战经验与流程规范。 Discussion Focus: It is recommended to center the discussion on "Precise Preoperative Decision-Making for High-Risk Redo TAVR, the Art of Valve and Sizing Selection, and the Electrosurgical Prevention of Fatal Complications." Key areas of exploration include the real-world clinical choice between Redo TAVR and surgical explantation (Explant), the utilization of preoperative CT anatomical parameters (such as valve-to-coronary [VTC] distance and the original valve frame height) for risk prediction, technical maneuvers for deploying balloon-expandable valves in re-interventions, as well as practical experience and procedural standardization of electrosurgical techniques (e.g., BASILICA) in defending the coronary "lifeline."

讨论建议 建议讨论问题 1. Redo TAVR vs Explant的抉择： 面对TAVR瓣膜衰败的极高危患者，临床上如何量化评估，在微创再介入（Redo TAVR）与外科直视手术（Explant）之间做出最优抉择？ How should clinicians quantitatively assess and make optimal decisions between Redo TAVR and surgical explantation (Explant) for extremely high-risk patients with failed TAVR valves? 2. 术前CT精准解剖评估： 在Redo TAVR的“精准画像”中，哪些核心解剖指标（如VTC距离、原有瓣膜支架高度、窦管交界高度等）是预测冠脉阻塞和评估手术可行性的决定性权重因素？ In the preoperative anatomical analysis for Redo TAVR, which core anatomical parameters (e.g., VTC distance, original valve frame height, STJ height) are the decisive factors for predicting coronary obstruction and assessing procedural feasibility? 3. 球扩瓣选择与尺寸策略： 针对第一代不同类型（自膨胀 vs 球扩）的衰败瓣膜，二次介入时选用球扩瓣的尺寸匹配策略有何异同？如何兼顾避免瓣中瓣严重狭窄与防止过度扩张导致的血管/瓣环损伤？ What are the similarities and differences in sizing strategies when using balloon-expandable valves for re-intervention across different types of failed first-generation valves (self-expanding vs. balloon-expandable)? How do we balance avoiding severe patient-prosthesis mismatch (THV-in-THV) and preventing annular/vascular injury from over-expansion? 4. 电外科技术的实战规范： 电外科技术（如人工瓣叶切开术/BASILICA等）作为应对冠脉阻塞风险的“最后防线”，其在Redo TAVR中的规范化操作流程、关键技术难点及围术期安全保障如何？ As the "final line of defense" against coronary obstruction, what are the standardized procedural steps, key technical challenges, and perioperative safety guarantees for electrosurgical techniques (e.g., leaflet laceration/BASILICA) in Redo TAVR? 5. 多学科（MDT）应急与并发症防治： 针对这种“极高危·再介入”的复杂术式，心血管内外科、影像科、麻醉科等多学科团队如何建立高效的术中联合保障与应急机制，以应对突发的循环崩溃、瓣膜移位或急诊转外科情况？ For this extremely high-risk re-intervention procedure, how should the multidisciplinary team (MDT)—including interventional cardiology, cardiac surgery, imaging, and anesthesiology—establish efficient intraoperative coordination and emergency protocols to handle sudden circulatory collapse, valve migration, or emergency surgical conversion?d outpatient follow-up?

病例汇报： Case report:

困境与出路： Dilemma and Way Out: TAVR 瓣膜衰败的再处理模式Redo vs Explant Re-treatment Modes for TAVR Bioprosthetic Valve Failure—Redo TAVR vs. Explant

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精准画像： Precision Profiling: Redo TAVR 术前评估与解剖分析要点 Key Points of Preoperative Assessment and Anatomical Analysis for Redo TAVR

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排兵布阵： Strategic Deployment: Redo TAVR 的瓣膜选择与尺寸策略 Valve Selection and Sizing Strategies in Redo TAVR

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生命线保卫战： Defending the Lifeline: 冠脉阻塞风险的识别与应对措施 Identification and Mitigation of Coronary Obstruction Risks

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最后的防线： The Final Line of Defense: Redo TAVR 中的电外科技术应用 Application of Electrosurgical Techniques in Redo TAVR

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