IC: You mentioned in your talk yesterday about expanding the use of TAVI， do you see a future there?
　　Dr. Applegate: The expansion of TAVI will likely be in two areas， though it will still be limited to patients with severe aortic stenosis. The CoreValve study is already expanding the use of the extreme risk registry. Now， patients who physicians believe have severe aortic stenosis， but who do not qualify for the gradients requirements of the trials， will be able to receive TAVI treatment. This is one of the areas of expansion: patients who have severe aortic stenosis with low output. We also have another group which has a normal ejection fraction and a low gradient， but because their chamber sizes are small， they cannot generate a large gradient despite having severe aortic stenosis. The other group of patients is those who are poor operative candidates. If two surgeons determine a significant risk of co-morbities， then TAVI will be preformed instead of surgery. As we look forward， gain experience， and solve complication issues， we are going to expand TAVI into patients who have different risk profiles， in other words， lower risk patients. The SURTAVI trial， headed by Patrick Serruys， is underway and will be launched in the next several months in the United States to examine a lower-risk cohort of patients. I think that is appropriate as we see the durability of TAVI established. The relative risk of the procedure itself is not great， but it is acceptable for a life saving therapy. We hope to see TAVI migrate in that those directions.
　　《国际循环》：您昨天在演讲中提到扩展TAVI的应用，你是否看好TAVI的未来？
　　Applegate教授：TAVI的扩展会体现在两个领域，尽管当前TAVI还仅限于重度主动脉瓣狭窄的患者。CoreValve研究已经在注册的高风险患者中扩展了TAVI的使用。那些医生认为，有重度主动脉瓣狭窄但不符合试验的跨瓣压差要求的患者可接受TAVI治疗。这就是扩展的一个领域：低心输出量的重度主动脉瓣狭窄患者。还有另外一组射血分数正常且跨瓣压差低的患者，但是由于心腔体积小，这些患者虽然有重度主动脉瓣狭窄，但没有大的跨瓣压差。还有一组患者是不适合手术治疗的患者。如果两位外科医生认为患者的并存疾病有明显风险，就不会给患者做外科手术而是选择TAVI。随着我们不断向前，获得经验和解决并发症的问题，我们就会将TAVI扩展到不同风险水平的患者，换句话说是风险较低的患者。Patrick Serruys教授所牵头的SURTAVI试验目前正在筹备当中，几个月后将在美国启动，该试验观察了低危患者。我认为这是合适的，因为我们看到TAVI的长期效果得以确立。TAVI操作的相对危险不大，它作为挽救生命的措施是可以被接受的。我们期望看到TAVI能够向此方向发展。
 

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