<International Circulation>:  Different access routes have been proposed for TAVI including transapical， transsubclavian and transfemoral. Which route do you prefer to use and why?

  《国际循环》：TAVI手术入路包括穿间隔，经锁骨下静脉，经股动脉，您如何选择？为什么？
    Prof Kuck: Most of our patients are done using the transfemoral approach as whenever the femoral and iliac arteries are above 6mm in size， we can easily use this approach. It becomes a little more complicated if these vessels are too small (<6mm) and then the decision has to be taken whether to go transapical or look for another access site. We have developed a pure percutaneous approach to use the axillary artery. The reason for this is because these procedures using the transfemoral or transaxillary can be done without general anesthesia. Once you move to the transapical approach， you then require an anesthesiologist and the risk of a general anesthesia. Most of these patients are very old patients and also at very high risk for general anesthesia and suffer subsequently in the CCU on awakening. We would prefer to have a patient we can talk to during the procedure， who is sedated but not under general anesthesia.

    Kuck教授:  多数患者我们会选择经股动脉入路，因为股动脉或髂动脉的管径在6mm以上，比较容易穿刺。但如果动脉管径在6mm以下就比较困难，需要寻找其他入路。我们用腋窝动脉作为经皮介入治疗的专用通路，因为这种穿刺不需要全身麻醉，而如果采用经心尖途径需要麻醉师辅助全身麻醉。接受手术的大多为老年患者，如果全麻的话风险很高，并且需要在ICU度过术后的催醒期。相比而言，我们更愿意在术中和患者进行交流，患者可以服用镇静剂，但不是全身麻醉状态为好。