Transcatheter aortic valve implantation: Current status and future perspectives.
Transcatheter aortic valve implantation: Current status and future perspectives.
复制标题
经导管主动脉瓣植入：现状和未来前景。
DOI：
10.4330/wjc.v3.i6.177
复制
发表时间：
2011
影响因子：
1.9
通讯作者：
J. López
中科院分区：
文献类型：
--
作者：
P. Salinas;R. Moreno;J. López
尽管外科主动脉瓣置换术是严重主动脉狭窄(AS)的标准治疗方法，但由于不可接受的手术风险，约三分之一的患者被认为不能手术。在单纯的药物治疗下，这些患者的预后非常差，两年内的死亡率为50%。经导管主动脉瓣置入术(TAVI)已经应用于这些患者，并在迄今进行的唯一一项重症AS治疗的随机临床试验中显示出强劲的结果。在这篇综述中，我们将重点介绍两种商用系统：爱德华兹SAPIEN阀门和CoreValve再循环系统。在最近的经股动脉TAVI研究中，这两种系统的成功率都超过了90%，而30d死亡率低于10%。此外，长期的研究表明，这种瓣膜具有良好的血流动力学性能。一些研究目前正在探索在高危患者中TAVI手术与传统手术的非劣势，以及经皮瓣膜的长期临床结果。在这篇文章中，我们回顾了TAVI的现状，包括患者的选择，可用假体的比较，手术的结果和并发症，临床结果和未来的展望。
Although surgical aortic valve replacement is the standard therapy for severe aortic stenosis (AS), about one third of patients are considered inoperable due to unacceptable surgical risk. Under medical treatment alone these patients have a very poor prognosis with a mortality rate of 50% at 2 years. Transcatheter aortic valve implantation (TAVI) has been used in these patients, and has shown robust results in the only randomized clinical trial of severe AS treatment performed so far. In this review, we will focus on the two commercially available systems: Edwards SAPIEN valve and CoreValve Revalving system. Both systems have demonstrated success rates of over 90% with 30-d mortality rates below 10% in the most recent transfemoral TAVI studies. Moreover, long-term studies have shown that the valves have good haemodynamic performance. Some studies are currently exploring the non-inferiority of TAVI procedures vs conventional surgery in high-risk patients, and long-term clinical results of the percutaneous valves. In this article we review the current status of TAVI including selection of patients, a comparison of available prostheses, results and complications of the procedure, clinical outcomes, and future perspectives.