编者按：奥兰多当地时间2015年11月11日中午，美国心脏协会（AHA）2015科学年会落下帷幕。当天，《国际循环》记者在会议现场采访了AHA科学委员会主席Frank Sellke教授，与我们分享了本届会议的亮点、日程设置及主动脉瓣狭窄管理问题，并欢迎大家于下年到新奥尔良参加2016年会。Sellke教授是美国罗德岛医院和米瑞安医院心胸外科主任，美国布朗大学阿尔坡特医学院心胸外科教授，他的研究兴趣包括健康和疾病状态的微循环调节、心脏手术中的缺血损伤和炎症、侧支血管形成及采用生长因子和细胞疗法增加缺血组织血供。
International Circulation: Dr. Sellke， as this year’s Chairman of Committee on the AHA Scientific Sessions Program， could you please introduce the features of program settings and what are the highlights we should pay more attention to?
《国际循环》：作为今年AHA年会的科学委员会主席，请您介绍一下本届会议在日程设置上有哪些特点？有哪些亮点需要我们关注？
Dr. Frank Sellke: Good morning. We are just finishing the 2015 American Heart Association Scientific Sessions. This year the program was totally redesigned within the 3 science types; basic， clinic， and population. We have 30 tracks covering all aspects of cardiovascular science. We get 10 outstanding plenary sessions and 14 special sessions covering all aspects of cardiovascular science. A high point of the meeting is always the late breaking clinical trials. I have to say that the SPRINT trial was probably the highlight of this year’s meeting. This study compared the outcomes of patients who had their blood pressure controlled with a point of 140 versus a goal of 120. To a lot of people’s surprise， patients who had their blood pressure more aggressively treated actually did much better. This trial was sponsored by the National Institutes of Health and was stopped prematurely because the outcome was so obvious. Another highlight I believe， one of my personal favorites， was the 2 year follow up results of the severe mitral regurgitation trials sponsored by the Cardiothoracic Surgery Network and the National Institutes of Health. 2 years ago， the 1 year follow up study was reported at the Scientific Sessions and they found that mitral valve repair for severe mitral regurgitation actually did somewhat poorer than those patients that had those replacements. Now a lot of surgeons and cardiologists feel that repair should always be performed over replacement， however， this study showed that that may not always be the case. A lot of us thought that perhaps with longer time， patients with repair would do well or do better than replacement. However， in this situation， the previous results pretty much held that patients that had the replacement had a more durable operation， they had less recurrent mitral regurgitation， and fewer readmissions to the hospital for heart failure. Another potentially important study was one from British Columbia in diabetic patients comparing whether coronary bypass surgery or PCI would be better for the treatment of patients with acute coronary syndrome. Again， these patients were at high risk， they had diabetes， and they found that patients undergoing bypass surgery， certainly in the short term， did much better than those that had PCI. After 30 days， there was not much of a difference over what had been reported previously， but in the acute situation， people tend to do much better with coronary bypass if they have 3 vessel diseases and if they have a lot of risk factors for a poor outcome.
Frank Sellke教授：大家早上好。2015年AHA年会刚刚结束。今年AHA会议日程根据基础、临床与人口科学三大类别进行了重新设计，分为30个路径，涉及心血管科学的各个方面。此外，大会还设立了10个优秀全体会议和14项专题会议，覆盖了心血管科学的各个方面。最新临床试验专场一直是AHA年会的一大亮点。在大会发布的众多临床试验中，SPRINT试验无疑是亮点中的亮点。该研究对将收缩压降至140 mm Hg以下及120 mm Hg以下的患者结局进行了对比分析。出乎很多人意料的是，更积极的强化降压治疗确实能够为患者带来获益。该研究由美国国立卫生研究院（NIH）资助，因其得到了非常明显的阳性结果而提前终止。大会的另一个亮点，也是我个人喜欢的内容之一，是由心胸外科网络及NIH联合资助开展的一项有关严重二尖瓣反流试验的2年随访结果。2年前的AHA年会上发布了该研究的1年随访结果，其结果显示，与接受二尖瓣置换术者相比，接受二尖瓣修复术治疗的严重二尖瓣反流患者结局稍差。很多外科医生及心脏病专家认为二尖瓣修复术可能会优于置换术，但该研究发现并非如此。很多人认为可能随着研究随访时间延长，二尖瓣修复术可能会达到与置换术相当或更好的效果。但实际上，既往已有研究支持行二尖瓣置换术的患者手术效果更持久，更少出现二尖瓣反流复发，更少因心力衰竭再住院。另一个非常重要的研究是加拿大英属哥伦比亚大学研究者开展的一项探讨对合并急性冠状动脉综合征的糖尿病患者而言，CABG与PCI何者更优的研究。这些患者有糖尿病，属于高危患者。研究发现，从短期来看，与PCI相比，CABG更好；但两种治疗术后30天的结局无太大差异。但在紧急情况下，若患者合并3支血管病变或伴可导致结局较差的多种危险因素，CABG效果可能会更好。
International Circulation: We noticed that more than 30 International Joint sessions with AHA will be held this year. How do you evaluate the specific and positive effects of this collaboration on promoting the scientific research and prevention of global cardiovascular diseases?
《国际循环》：我们发现，今年AHA与世界其他学会或机构举办了30多场联合论坛。您认为，这种形式的合作在推动全球心血管疾病防治与科研方面发挥了哪些具体的、积极的作用？
Dr. Frank Sellke: Well， the American Heart Association’s Scientific Sessions clearly is an international meeting. Over 50% of the attendees are from abroad and outside North America and over 30% of the educational content and presentations are from people outside North American. So again， this is clearly an international meeting. We have increased the number of joint sessions with international societies from China， from European Society of Cardiology， from South American， and from all over the globe. We do this because it is clearly an international meeting and there is tremendous content from these other meetings from outside of North America. We like to include that in our program here as well. Global health is becoming more and more of an issue， and the prevention of cardiovascular disease not only in North America， but also outside of North American and in Asia and South America， which is very important. We feel that that would further that goal.
Frank Sellke教授：很显然，美国心脏协会科学年会是一个国际性会议，有超过50%的参会者来自美国及北美以外的其他国家，超过30%的会议内容及讲座由北美以外地区的专家报告。本次大会与中国、欧洲、南美及全球各地的其他学会举办了联合论坛。我们这样是因为AHA年会是一个国际性会议，北美以外地区有很多学术内容呈现。我们希望我们的日程能包含这些内容。此外，在北美及北美外其他地区如亚洲及南美等全球健康均受到越来越多的关注，变得非常重要。我们可更进一步促进这一目标实现。
International Circulation: On Saturday， there are a lot of training courses for early career physicians. You moderated a session and gave a report. In your opinion， how can we find good mentors and develop mentor relationship in the field of cardiovascular surgery?
《国际循环》：周六本届会议针对职业生涯早期人员开展了大量培训课程。您也主持了其中一场专题，并作了报告。在您看来，在心血管外科领域，应如何寻找好的导师并建立良好的教导关系？
Dr. Frank Sellke: The American Heart Association puts a lot of weight in bringing the new generation of investigators and clinicians into practice. For that reason， the first day of scientific sessions is really devoted to the young investigator and the young clinicians. We have a lot of programs for the young members. I personally moderated a session on everything you want to know in cardiothoracic surgery about becoming successful both in research and clinically. We had a truly outstanding program. We had leaders from the field， we had Duke Cameron and Bill Baumgartner， and many other great surgeons. We feel that these kinds of programs will really further the career of these young members and again， it is really been emphasized by the American Heart Association.
Frank Sellke教授：美国心脏协会非常关注新一代研究人员及临床医生的培养与实践，因此，年会第1天真的是专门为年轻研究者及年轻临床医生所准备的，大会为年轻人提供了很多日程。我个人主持了其中一个专题，是关于心脏外科领域所有你想知道的非常成功的研究及临床方面内容。这是一个非常棒的日程，邀请了Duke Cameron、Bill Baumgartner及很多其他外科医生等领域权威参加。我们认为，这类日程真的对年轻人的早期职业生涯有促进和推动作用，非常受美国心脏协会的重视。
International Circulation: For aortic stenosis patients， how to determine whether they should undergo transcatheter or surgical aortic valve replacement? And what do you think their limitations?
《国际循环》：对于主动脉瓣狭窄的患者，应如何决定接受经导管介入治疗还是外科主动脉瓣置换？两者各有什么局限性？
Dr. Frank Sellke: Well， the treatment of aortic stenosis has really changed in the last 5 or 10 years. It used to be that the only options were medical therapy which was not very good， or surgery. Unfortunately， a lot of the patients that are very elderly and very frail did not do too well with the aortic valve replacement. Transcatheter aortic valve replacement offers these patients a much better option. The results are getting much better and they are so much better that many feel that all patients who have aortic stenosis should be treated with a transcatheter approach. I am not sure we are quite there yet， but that is open to debate and like I said， things are changing so quickly， we may actually get there in the next 10 or 20 years. My question is how to best evaluate these patients. Certainly， we have to look at the vasculature with the CT angiography， we have to look at the coronary arteries and do an assessment of how frail or active these patients are and what their chances are for a meaningful recovery is. Again， as the results of both surgery and transcatheter aortic valve replacement are both improving， this is a moving target. For right now， I think for the low risk patients and probably the better intermediate risk patients， surgery continues to be the best option. For the highest risk patients， those that are very frail or have some comorbid conditions that would preclude a good surgical result， transcatheter approach is clearly the best given the indications. It is kind of the middle group that is at intermediate risk that continues to be in transition.
Frank Sellke教授：过去5~10年，主动脉狭窄治疗发生了变化。原来治疗该病的唯一选择是药物治疗或手术治疗，但药物治疗效果不太好。非常不幸的是，很多患者年老体弱，外科主动脉瓣置换术效果不是非常好。经导管主动脉瓣置换术为这些患者提供了一种更好选择。很多人因此认为所有主动脉狭窄患者都应接受经导管主动脉瓣置换术治疗。我对此还不太确定，但目前这方面存在争论。正如我所说，事情变化很快，可能在未来10年或20年会得到明确答案。我认为问题在于如何对这些患者进行最好的评估。当然，我们肯定需要采用CT血管造影观察其血管系统、冠状动脉，需要评估患者的身体及活动情况及恢复概率。此外，鉴于经导管主动脉置换术与外科主动脉置换术的结果都在改善，这是一个持续目标。目前来看，我认为对于低危及情况较好的中危患者，外科主动脉瓣置换术仍是最佳选择；对于体弱及伴影响手术结局的合并症的高危患者而言，经导管主动脉瓣置换术很显然是最佳选择。就中危患者而言，最佳治疗选择仍存在争议。
International Circulation: Would you like to add some comments about this meeting or talk to your Chinese peers?
《国际循环》：您还有哪些想要补充的评论？还有哪些内容想与中国同道说？
Dr. Frank Sellke: We are just concluding the 2015 scientific sessions. It has been a truly outstanding meeting. The program has been totally redesigned; we have increased number of educational programs， maintenance and certification programs， and simulation education programs， in addition to the great array of clinical and basic population research. Thousands of original research presentations have really added to the content of the meeting. The high point is always the late breaking clinical trials and I think the SPRINT trial was certainly the high point of this meeting. It demonstrated that a more aggressive approach to the treatment of hypertension is in the patient’s best interests. Other trials dealing with heart failure have been very instructive. The Cardiothoracic Surgery Network’s Severe MR trial again was a surprise to many people. The CPR trial， looking at continuous versus intermittent chest compressions was evaluated. There is actually no difference between the two. Again， after 50 years or more of CPR you would think we know the best way to do this， but because of continued innovation and continued research， we are going to continue to look into this to try to determine the best way to resuscitate patients who suffered a possible cardiac arrest. I think the meeting overall has been outstanding and I look forward to next year’s meeting on November 12 to 16， 2016 in New Orleans. Hope to see you there!
Frank Sellke教授：2015年AHA年会已闭幕，这次大会真的非常棒。其日程得到了完全重新设计，增加了大量教育项目、维护及认证项目、模拟教育项目、临床及基础人口学研究。研究包含数千项原创性研究报告，大会亮点则是最新临床试验专题。我认为SPRINT试验是亮点中的亮点，它表明更积极治疗高血压能为患者带来获益。另外，有关心力衰竭的临床试验也非常具有启发性。心胸外科网络资助的严重二尖瓣反流试验结果也出乎很多人的意料。旨在比较持续及间断胸外按压的CPR试验发现，两者效果并无差异。随着创新及研究的发展，我们在不断努力探寻拯救心搏骤停患者的最佳方法。相信在CPR历经50年或更长时间发展后，我们有可能会找到最佳CPR方法。我认为，总体来说，这次大会非常棒，我对明年11月12~16日将在新奥尔良举行的2016 AHA年会非常期待，希望能在那里与大家再次相见。
reporter Zhang jingjing