Kapadia Samir R, Tuzcu E Murat
Department of Medicine, Cleveland Clinic, 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA.
Curr Treat Options Cardiovasc Med. 2009 Dec;11(6):467-75. doi: 10.1007/s11936-009-0049-x.
Aortic stenosis is the most important valvular heart disease affecting the elderly population. Surgical aortic valve replacement is the mainstay of treatment, although a substantial number of patients are considered high risk for surgery. Many of these patients do not undergo surgery and have poor outcomes from medically treated symptomatic, severe aortic stenosis. Transcatheter aortic valve implantation (TAVI) provides a promising treatment option for some of these patients. Several devices are under investigation. The Edwards Sapien valve (Edwards Lifesciences, Irvine, CA) and the CoreValve (Medtronic, Minneapolis, MN) have the largest human experience to date. Initial data suggest that these devices have an acceptable safety profile and provide excellent hemodynamic relief of aortic stenosis. The Edwards Sapien valve is currently under investigation in the United States in the PARTNER (Placement of Aortic Transcatheter Valve) trial in high-risk surgical or inoperable patients; TAVI is available for clinical use in both Canada and Europe. TAVI is not used in low- or intermediate-risk surgical patients; however, future studies may prove its applicability in these subsets. The major complications of TAVI include access site-related problems and device malpositioning/migration. There are several new-generation prosthetic valves and delivery systems designed to be low profile and repositionable. Technical advances and refinement of the implantation methods may make TAVI even safer and ultimately a better treatment option, not only for patients with high surgical risk but also for those with moderate or low risk.
主动脉瓣狭窄是影响老年人群的最重要的心脏瓣膜疾病。外科主动脉瓣置换术是主要的治疗方法，尽管相当一部分患者被认为手术风险高。这些患者中有许多人未接受手术，并且因药物治疗有症状的重度主动脉瓣狭窄而预后较差。经导管主动脉瓣植入术（TAVI）为其中一些患者提供了一种有前景的治疗选择。几种装置正在研究中。爱德华兹Sapien瓣膜（爱德华兹生命科学公司，加利福尼亚州欧文市）和CoreValve（美敦力公司，明尼苏达州明尼阿波利斯市）迄今为止拥有最大规模的人体使用经验。初步数据表明，这些装置具有可接受的安全性，并能显著缓解主动脉瓣狭窄的血流动力学状况。爱德华兹Sapien瓣膜目前正在美国进行PARTNER（经导管主动脉瓣植入）试验，用于高风险手术或无法手术的患者；TAVI在加拿大和欧洲均可用于临床。TAVI不用于低风险或中等风险的手术患者；然而，未来的研究可能会证明其在这些亚组中的适用性。TAVI的主要并发症包括与入路部位相关的问题以及装置位置不当/移位。有几种新一代人工瓣膜和输送系统设计得外形小巧且可重新定位。技术进步和植入方法的改进可能会使TAVI更安全，最终成为更好的治疗选择，不仅适用于高手术风险患者，也适用于中度或低风险患者。
