<International Circulation>: According to the study you published in In June 2008， we know that the incidence of significant left-sided valvular disease (MR) after orthotopic heart transplantation was low. For such a population， how should we optimize our treatment strategy to improve their outcomes?

《国际循环》：根据您2008年6月发表的研究，我们知道原位心脏移植术后严重左侧瓣膜病变（二尖瓣返流）的发生率较低。对于此类患者，我们应该如何优化治疗策略以改善他们的转归？
Prof. Pomar: In these types of patients who have a new left side valve incompetence， regurgitation is usually due to a chronic rejection. We know that the results of retransplantation are not good， especially if the patient has a problem with immunosuppression. What we try to do is to repair the mitral valve. We do not attempt to do too much with the ventricle. It makes sense to have only a mitral repair because even with remodelling， the ventricle does not enlarge very much. It is mainly a type of diastolic problem in those patients. We try to repair it with a ring and so far our experience has been rather good. However， I must note that some of our patients required retransplantation after some time.
 

Prof. Pomar:左侧瓣膜关闭不全的患者发生返流通常是由慢性排斥反应所致。我们知道再移植的结果并不乐观，特别是在免疫抑制上存在问题的患者。我们设法修补二尖瓣，但并不对心室做太多操作。仅修补二尖瓣是合理的，因为即使是进行重塑，心室也不会扩大过多。这些患者主要在心脏舒张方面存在问题，我们尝试用一种环形装置修补二尖瓣，到目前为止，我们在这方面有很好的经验。但是，我们的一些患者在一段时间后仍然需要再次移植。 
 

<International Circulation>: What is your opinion of CABG by robot? Is it feasible at this time?
《国际循环》：您对机器人行CABG有何看法？目前它是否可行？

Prof. Pomar: I have seen some surgeons doing CABG by robot. My first thought was that it was going to be very impractical. The time you spend doing a bypass operation with a robot is very long， perhaps 3~4 times longer than a regular operation. However， you have some people who are devoted to it and do it very well. I think it is going to be a good tool but will need sub specialization and good skills as in any new technique.
Prof. Pomar: 我见到过一些外科医生通过机器人进行CABG。我的第一个看法是，这非常不切实际。用机器人进行旁路术所花费的时间非常长，可能比常规手术长3~4倍。但是，有些医生对此非常热衷，而且做得很好。我认为它将来可能会成为很好的工具，但是同其它任何一个新技术一样，需要专业化和很好的技术性。

<International Circulation>: What is your view on non-surgical methods to treat valve diseases， for example， percutaneous aortic valve replacement with stent systems， percutaneous valve repair， and percutaneous valvuloplasty?

《国际循环》：您对非手术方法治疗瓣膜病变有何看法？例如使用支架系统经皮主动脉瓣置换术、经皮瓣膜修复术和经皮瓣膜成形术。
 

Prof. Pomar: This is a new procedure， which is expensive， but I think it is worth doing it because these patients deserve a good quality of life. They are not treated the same way we do with normal valves and they are anchored to a very rigid frame. We have known for years that flexibility of the stent is crucial to reduce stress on the commissures and now suddenly we are doing this with very rigid stents. Is this going to have an impact on the durability of these valves? If we have a patient who is 86 years old and we know has a coronary artery disease and mitral or aortic disease， we know that life expectancy is going to be 4~6 years at most. Therefore， if we have a valve that is going to be able to give 5~6 years of good quality life then that is good. However， we cannot do the same thing with a 60 year old patient and conventional surgery will also get better with time. It is a real challenge and a great opportunity.

Prof. Pomar：这是一种新型操作，价格昂贵，但我认为这是值得的。它们与正常瓣膜的处理方式不同，被固定在一个非常坚硬的框架上。我们很早就知道，支架的弹性对于降低连接处的压力至关重要，现在，我们用很硬的支架来代替，这是否将会影响这些瓣膜的耐用性？如果是一名患有冠状动脉疾病和二尖瓣或主动脉瓣病变86岁的患者，并且知道他的预期寿命最多是4~6年，那么，如果我们的瓣膜能够为患者提供5~6年的优质生活，那就很好。但是，我们不能对60岁的患者做出同样的选择。随着时间的推移，传统的外科手术同样会获得较好的结果，那将是真正的挑战和很好的机会。