International Circulation: Complex and high-risk interventional procedures are a key concern for physicians as well as the revascularization of high-risk and complex patients. Do you have any tips or tricks to the approach of complex coronary interventions?

　　《国际循环》：复杂高危介入手术是临床医生及高危复杂患者血运重建需要注意的关键问题。就复杂冠状动脉介入治疗而言，您有何要诀或技巧？

　　Dr Kirtane: The issue of complex interventions is something that many interventionalists try to achieve and they want to know how to do these procedures safely. But it is not only about the procedures; it is about the patients. The key aspect of this is that there are many patients with significant coronary disease， significant symptoms and complex anatomy who are undertreated. As interventionalists， it is up to us to determine whether we see these patients and if so， how can we treat them appropriately and safely using the best tools and techniques we have today.

　　Kirtane教授：很多介入医生都在努力争取做到能够实施复杂介入手术，也希望知道如何更安全地进行这些复杂介入手术。但是，复杂介入手术不仅要关注手术本身还要关注患者。之所以这样说，是因为有很多伴有明显冠状动脉疾病、症状比较明显但解剖比较复杂的患者未能得到充分治疗。作为介入医生，我们需要确定我们的患者是否存在这种情况，如果是的话，我们需要知道应如何采用现有的最佳工具及技术对这些患者进行适宜和安全的治疗。

　　International Circulation: Recent controversial clinical trials and translation into daily practice are challenging the norm. Why do high-risk patients not follow the trends in clinical practice?

　　《国际循环》：近期一些比较有争议的临床试验及其临床实践转化都对现有常态提出了挑战。为何对高危患者而言我们不能遵循临床实践中的一般趋势？

　　Dr Kirtane: When we look at global trial data， often these patients are the sickest and often not randomized in clinical trials. On one hand， randomized trials can help us determine how to treat patients， but especially with patients who are at high risk， they are often undertreated and unrandomized， so it behooves us as clinicians to make sure we can treat them safely and effectively.

　　Kirtane教授：从全球试验数据来看，通常高危患者病情比较严重，往往不被随机试验所入选。一方面，随机试验可帮助我们确定如何治疗患者；但是，另一方面高危患者却通常存在治疗不足，也未得到随机化。因此，作为临床医生，我们理应确保我们能够对高危患者进行安全有效的治疗。

　　International Circulation: For cardiogenic shock， has there been any progress， paradigms or unresolved problems in recent years?

　　《国际循环》：近年来，有关心源性休克有何进展、管理模式及尚未解决的问题？

　　Dr Kirtane: In cardiogenic shock， this is a group of patients who have an extraordinarily high mortality. These patients don’t do well. We do feel that if we can support them through the initial event then that is the best chance for myocardial recovery. The new paradigms for many of these patients involve complex hemodynamic support and there are devices that can be used in that particular scenario to support the heart and allow it to recover and then either have a bridge to long-term ventricular assistance， transplantation or， in many cases， recovery. The understanding of the use of these devices is very critical.

　　Kirtane教授：心源性休克患者的死亡率非常高，状况一般都不太好。对这些患者而言，发生最初事件时是我们提供帮助促进其心肌恢复的最佳时机。对很多心源性休克患者而言新管理模式强调要提供复杂的血液动力学支持。现在已经有可在特定情况下用于给患者提供心脏支持以促进其恢复的设备，这些设备或是可以帮助患者进行过渡以进行长期心室辅助、移植或是可促进心脏恢复。了解这些设备的应用无疑是非常关键的。

　　International Circulation: What is the role of circulatory support in ACS and in shock?

　　《国际循环》：循环支持在ACS及休克患者管理中的作用是什么？

　　Dr Kirtane: For acute coronary syndrome patients who have myocardial dysfunction， ventricular support can be critical in allowing those patients to survive the initial hospitalization and then regain good function and quality of life. If clinicians don’t have familiarity with these techniques， they need to obtain it and then be able to apply it safely in the correctly indicated patients.

　　Kirtane教授：对伴有心肌功能不全的急性冠状动脉综合征患者而言，心室支持对确保这些患者在初始住院时得以生存并在随后恢复较好的功能、拥有良好的生活质量至关重要。如果临床医生并不熟悉这些技术，则需要学习并能够将其安全正确地应用于需要应用的患者中。