1. <International Circulation>：Please give us a summary about your representation and other important developments of intervention cardiology in this meeting?

《国际循环》：请您总结一下在此次大会上您的议题，还有哪些值得关注的关于介入心脏病学的进展？

Prof.Timothy A. Sanborn:I am an interventional cardiologist. And I am here for the Society of Cardiac Angiography and Interventions and we have a number of presentations. I am co-chairing a session this afternoon on treatment of heart attacks with various types of stents， drug eluting stents and the bare metal stents. There are some studies of the different antiplatelet agents， cilostazol， aspirin， it’s interesting to hear that’s an actually presentation from the Orient. I am anxious to hear what they say. I am also presenting some information on cardiogenic shock， that will be Tuesday and also a discussion of vascular closure devices to seal the artery after the intervention to try to decrease the risk of bleeding， get patients up on ambulating quicker. Those are some of the things that are going on.

The most interesting areas are the treatment of valvular heart disease with non-surgical treatment， percutaneous valve treatment. They are now taking patients with mitral valve prolapse and putting a clip on the leaflet so that you can reduce the mitral regurgitation without having to send the patient to surgery. Also there are some very exciting work on percutaneous aortic valve replacement， with catheter based technique. So I am anxious to see those reports also. So I think at least in the US， the treatment of patients with CHD with angioplasty and stents is actually decreasing as we take better care of our patients with statins for prevention and the drug eluting stents. So the number of patients that come to our catheterization laboratories for coronary disease is decreasing. However， we are starting to see an increase in the treatment of valvular heart disease in the catheterization laboratory.

Historically， in the 1990s， we had techniques to open up stenotic aortic valve with balloon valvuoplasty， however the long-term success was not very good. In other words， the valve would develop fibrosis and scar up so the aortic stenosis will come back. During the last few years， there have been a number of techniques to actually put in a brand new valve. It’s mounted on a stent， so the stent goes in and expanded， and the valve is the same material that is used by the surgeon to replace aortic valves. It just happens to be mounted on a stent. It does require some large equipment， so there are some limitations in gaining access from the femoral artery. For those patients， there is also what is called an apical approach where the surgeon places this device through a direct apical incision. That is less invasive， less surgery than sternotomy.  

Timothy A. Sanborn教授：我是一名心脏介入治疗医生。在此次大会上，我代表美国心脏血管造影和介入协会参与了多项议题。今天下午我主持的一项议题是关于各种支架用于心脏疾病的治疗，包括药物洗脱支架和金属裸支架。目前有关于不同抗血小板药物（例如西洛他唑和阿司匹林）的研究。我非常关注讲座的内容。同时在周二我也会介绍有关心源性休克的一些内容。同时讨论心脏介入治疗时用于闭合动脉的血管封堵器，目的是降低出血风险。使患者能够尽早活动。这就是部分议题。

本次会议上最有意思的领域是心脏瓣膜病的非手术治疗，即经皮瓣膜介入治疗。目前是在二尖瓣脱垂患者的瓣叶上放置夹合器（clip），可以减少二尖瓣返流，无需对患者进行手术治疗。此外，也有关于经皮主动脉瓣置换术非常令人鼓舞的研究，是经导管置换。我非常想知道该研究的结果。我认为，用他汀类药物来预防以及置入药物洗脱支架使得我们能够更好地处理患者，这使得实施血管成形术和置入支架的CHD患者逐渐减少，至少在美国是如此。因此，进入导管室的CHD患者人数减少。相比之下，可以看到在导管室中治疗瓣膜疾病的患者人数增加。

从历史上来看，20世纪90年代就出现了采用瓣膜球囊成形术来扩张狭窄主动脉瓣的技术。但是远期疗效不太理想，瓣膜会发生纤维化和瘢痕形成，再次出现主动脉瓣狭窄。近几年出现了一系列能够置入新瓣的新技术。将置换瓣放在支架上，支架进入心腔后扩张，瓣膜的材料和外科医生所用主动脉瓣的置换瓣相同，区别为置于支架上。此种瓣膜置换术需要某些大型设备，因此对于经股动脉入路存在一些局限性。对这些患者还可以采用心尖入路，即医生通过心尖切口置入新瓣。其损伤性更小，操作比胸骨切开术更为简单。

2.<International Circulation>：We know that cardiogenic shock accounts for the majority of in-hospital deaths among acute MI (AMI) patients.Though PCI can save lots of lives， it is very important to choose  patients suitable for this treatment. My question is what are the predictors of clinical outcome after percutaneous treatment for cardiogenic shock？

《国际循环》：我们知道，在急性心肌梗死患者中，大多数患者因为心源性休克而死亡。虽然PCI可以挽救很多患者的生命，但是选择合适的病例就显得非常重要了。我的问题是：经皮介入治疗心源性休克患者临床结果的预测因素都有什么？

Prof.Timothy A. Sanborn:I think one predictor of a good outcome is if a patient is in shock， and you revascularize them with angioplasty or with bypass surgery and the hemodynamics improved， then that’s a good predictor of a better outcome than if the hemodynamics do not improve. In other words， the BP， or the cardiac output， so if you see a rapid improvement in those hemodynamic parameters. Then there is a greater chance that the patient will survive. If the intervention (stenting or bypass surgery) doesn’t improve the hemodynamics， then there is less chance of survival. Even with our early intervention that we learned from the SHOCK trial， there is still an almost 50% mortality if somebody comes in with a heart attack and it’s complicated by cardiogenic shock. So one of the sessions that I am going to be involved in will discuss whether we should look at new left ventricular assist devices to help stabilize these patients， get them to the point where maybe they improve or there is a candidate for heart transplant. So that I think is another frontier.

Timothy A. Sanborn教授：我认为，对于休克患者来说，如果医生实施血管成形术或旁路手术使血管再通后患者的血流动力学参数有所改善，就是预后良好的一个指标。也就是血压上升或心输出量增加。因此，如果你看到上述血流动力学参数立即改善，患者就有更大的生存机会。如果介入治疗（例如支架置入或旁路手术）不能够改善血流动力学，则患者的生存机会降低。SHOCK试验显示，即使早期进行介入治疗，死亡率仍然达到50%。合并心源性休克会使心脏疾病患者的情况复杂化。因此，我要参加的一项议题就是讨论我们可能需要关注新型左室辅助装置，这些装置有助于稳定患者病情，使患者改善或是等到有合适的心脏移植供者。因此，我认为这是另一个前沿领域。

3. <International Circulation>：Is late PCI for STE-ACS necessary? When is the best time for delayed opening of infarct-related artery for the patient with STE-ACS?

《国际循环》：对于ST段抬高型急性心肌梗死患者，晚期PCI是否有必要？开通“犯罪”血管的延迟PCI最佳时间是何时？

Prof.Timothy A. Sanborn:Obviously， there is an adage that time is muscle and the sooner you open up an artery， the more you will preserve myocardial function. If there is a delay， then more tissue dies and heart function is reduced. And so there has been a lot of studies looking at what is that critical time and now looking at all the data， we actually have some guidelines and w