International Circulation: What about for patients who refuse surgery?
Dr. Leon:I think that if the patient is 75 with no comorbidities and a 1% risk of serious problems during surgery， I would convince the patient that it would be a terrible mistake for them not to have surgery. If that same patient is in their upper 80s， they have one or two comorbidities， and even if their risk score does not put them in the high-risk group. To me， that is a different structure.
《国际循环》： 对拒绝外科手术的患者，如何处理？
Dr. Leon：我认为，如果患者是75岁，没有合并症且术中严重问题的风险为1％，我会说服患者，对他们来说不接受手术治疗将会是一个可怕的错误。如果同样的患者已接近90岁，有一种或两种合并症，即使他们的风险评分并未将他们放在高危群体中，对我来说，这也是不同的结构体。
International Circulation: Could you discuss the idea of a heart team?
Dr. Leon: In the real world， everything is done under the aegis of physicians that speak together and with the patient to prevent all sides of the argument. The heart team is fundamental. One cannot get reimbursed in the US unless you have a heart team. One cannot even be trained or certified as a TAVR site unless you have a functioning heart team. In fact， you cannot get reimbursed by CMS unless you have a surgeon and an interventionist in the room for every procedure.
《国际循环》： 您能讨论一下心脏团队的想法吗？
Dr. Leon：在真实世界中，一切都是在医师的主持下进行，一起与患者商量以预防所有方面的争论。心脏团队是基础。在美国，如果没有心脏团队，你就不能获得保险公司或政府的支付。只有你有一个正常运作的心脏团队，你才能接受培训或被认证为TAVR中心。事实上，你不能得到CMS的赔偿，除非每个过程都有一位外科医生和一位介入医生在位。
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