A Review of Transcatheter Treatment of Valvular Heart Disease.pdf

To the Editor We believe the recent Review about transcatheter treatment of valvular heart disease has 1 important omission. The description of the “heart team” failed to include an anesthesiologist.

致编者 我们认为最近关于心脏瓣膜病经导管治疗的综述有一个重要的遗漏。“心脏团队”的描述没有包括一名麻醉师。

In addition to playing an important role in the medical evaluation and selection of patients who undergo this procedure, anesthesiologists administer sedation, general anesthesia, or both; administer as many as 10 additional potent nonanesthetic medications during the procedure; provide echocardiographic assessment and monitoring; work to maintain hemodynamic stability; provide resuscitation, if needed; and oversee recovery after the procedure.

除了在医学评估和选择接受此程序的患者方面发挥重要作用外，麻醉师还可以实施镇静、全身麻醉或两者兼而有之；在手术过程中施用多达 10 种额外的强效非麻醉药物；提供超声心动图评估和监测；努力维持血流动力学稳定；如果需要，提供复苏；并监督手术后的恢复情况。

All these duties are critical for a successful outcome in patients undergoing transcatheter treatment of valvular heart disease. In fact, the entire procedure would not be possible without the many services provided by the anesthesiologist.

所有这些职责对于接受心脏瓣膜病经导管治疗的患者的成功结果至关重要。事实上，如果没有麻醉师提供的许多服务，整个过程是不可能的。

In Reply We agree with Drs Katz and Suriani that anesthesiologists are integral and highly valuable members of the heart team. Their crucial contributions are one of the primary drivers for the excellent outcomes of transcatheter procedures. Our discussion regarding the heart team was intended to highlight the shared decision-making choices among transcatheter, surgical, and medical therapy options for patients with valvular heart disease.

在答复中 我们同意卡茨和苏里亚尼医生的观点，即麻醉师是心脏团队不可或缺且非常有价值的成员。他们的重要贡献是经导管手术取得优异结果的主要驱动力之一。我们关于心脏团队的讨论旨在强调瓣膜性心脏病患者在经导管、手术和药物治疗选择之间的共同决策选择。

Anesthesiologists provide conscious sedation in morethan 60% of patients undergoing transcatheter aortic valveimplantation, which has led to shorter hospital lengths ofstay, decreased in-hospital and 30-day mortality, and morefrequent discharge of patients to home. Intraproceduralechocardiographic guidance for mitral and tricuspid interventions are supported by cardiologists or anesthesiologistsbased on center practices.

麻醉师为 60% 以上接受经导管主动脉瓣植入术的患者提供清醒镇静，从而缩短住院时间，降低住院和 30 天死亡率，并让患者更频繁地出院回家。二尖瓣和三尖瓣干预的术中超声心动图指导由心脏病学家或麻醉师根据中心实践提供支持。

The success and delivery of high-quality care requires coordinated collaboration and communication from the heart team that extends to many others including, but not limited to, nursing, certified registered nurse anesthetists, technicians, sonographers, advance practice clinicians, and administrators.

高质量护理的成功和提供需要心脏团队的协调合作和沟通，该团队扩展到许多其他人，包括但不限于护理、注册注册护士麻醉师、技术人员、超声医师、高级临床医生和管理人员。