Karl-Heinz Kuck   德国汉堡大学
    <International Circulation>: Transcatheter aortic valve implantation (TAVI) is a rapidly emerging treatment option for patients with aortic valve stenosis and high surgical risk. The selection of candidates for TAVI is crucial for the success of the procedure. What is your patient assessment protocol?

  《国际循环》：主动脉瓣导管成型术（TAVI）是急诊主动脉瓣狭窄并存在外科治疗风险患者快捷的处理措施。患者和手术指证的选择决定手术是否成功，您是如何选择患者的？
    Prof Kuck: The first issue of course is to identify whether the patient is at high risk for surgery. There are clinical parameters， the so-called EuroSCORE， that we carefully assess and it is generally accepted today that if the patient has a EuroSCORE above 20， then we see them as a candidate for surgery. There are other factors that play an important role. One of these is the annular size. At this point in time， there are only valves available with an annular size from 23mm up to 29mm. In Germany， there are some patients with bigger annuli and we cannot implant them. We are just starting to use the 31mm valve which will further increase the number of percutaneous procedures. These are the major criteria: the clinical parameters on one side using the EuroSCORE; and the availability of the valve on the other side. Of course， we are then looking at patients， by definition， who are over 75 years of age， or younger patients with a higher EuroSCORE. 

    Kuck教授: 首先要确定患者是否存在外科手术的禁忌症。临床常用参的EuroSCORE评分的效力已被广泛认可，如果EuroSCORE评分超过20，我们建议行外科手术治疗。另外的重要影响因素包括：瓣环的型号，常用的有23-29mm。在德国，有的患者因需要更大型号的瓣环致使介入手术难以实施，而31mm的型号在经皮介入治疗中的应用才刚刚起步。利用EuroSCORE评分并有合适型号的瓣环可供手术成为筛选介入病人的首要条件，另外75岁以上或评分较高的年轻患者也有介入治疗的指证。