Kappert U, Joskowiak Dominik, Tugtekin S M, Matschke K
Klinik für Herzchirurgie, Herzzentrum Dresden GmbH Universitätsklinik, Fetscherstrasse 76, Dresden, Germany.
Clin Res Cardiol Suppl. 2011 May;6:49-57. doi: 10.1007/s11789-011-0025-3.
Calcified aortic stenosis is the predominant valve disease in the western world. Currently, surgical aortic valve replacement is the gold standard procedure for symptomatic severe aortic stenosis that can be performed with low morbidity and mortality. The prevalence of aortic stenosis increases with age, and the incidence of several comorbidities also unavoidably elevates the risk of surgical treatment. Therefore, the most adequate and gentle treatment is needed especially for this population. Since the first transcatheter aortic valve implantation (TAVI) was performed in 2002, the main implanting routes are the transfemoral, retrograde access through the common femoral artery, and the antegrade, transapical approach via anterolateral minithoracotomy. Meanwhile, TAVI has become an alternative treatment for patients who are not suitable candidates for surgical therapy in some centers.The initial clinical results are promising and have confirmed the feasibility of this technique. Due to the restricted long-term data, conventional aortic valve replacement still remains the standard for the treatment of aortic stenosis. Selection of the suitable therapy approach (surgical replacement, transfemoral or transapical aortic valve implantation) must consider each patient's specific risk profile and individual indication. Prospective, randomized trials will be necessary to assess the individual survival benefit of TAVI for various risk populations and to extend the indication.
钙化性主动脉瓣狭窄是西方世界主要的瓣膜疾病。目前，外科主动脉瓣置换术是有症状的重度主动脉瓣狭窄的金标准手术，该手术可在低发病率和死亡率的情况下进行。主动脉瓣狭窄的患病率随年龄增长而增加，多种合并症的发生率也不可避免地增加了手术治疗的风险。因此，尤其对于这一人群，需要最充分且温和的治疗。自2002年首次进行经导管主动脉瓣植入术（TAVI）以来，主要的植入途径是经股动脉，即通过股总动脉逆行进入，以及经心尖，即通过前外侧小切口经心尖顺行进入。同时，在一些中心，TAVI已成为不适于手术治疗患者的替代治疗方法。最初的临床结果很有前景，并证实了该技术的可行性。由于长期数据有限，传统的主动脉瓣置换术仍然是主动脉瓣狭窄治疗的标准。选择合适的治疗方法（外科置换、经股动脉或经心尖主动脉瓣植入）必须考虑每个患者的具体风险状况和个体指征。有必要进行前瞻性随机试验，以评估TAVI对不同风险人群的个体生存获益，并扩大其适应证。
