St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada.
J Am Coll Cardiol. 2012 Aug 7;60(6):483-92. doi: 10.1016/j.jacc.2012.01.071. Epub 2012 Jun 27.
Surgical aortic valve replacement (SAVR) has long been the mainstay of therapy for severe aortic stenosis. However, transcatheter aortic valve replacement (TAVR) is now generally accepted as the new standard of care for patients with symptomatic aortic stenosis who are not candidates for open surgery. Arguably TAVR may also be a preferred alternative to SAVR in carefully selected high-risk, but still operable, patients in whom morbidity and mortality may be reduced. Although TAVR outcomes continue to improve, concerns remain with respect to vascular injury, stroke, paravalvular regurgitation, and valve durability. However, it seems likely that with ongoing refinement of transcatheter valve systems, techniques, and patient selection TAVR is becoming an increasingly appealing option for a much broader range of patients. Randomized trials and ongoing surveillance will play an important role as we enter a new era of rigorous clinical evaluation for minimally invasive therapies for structural heart disease.
外科主动脉瓣置换术（SAVR）长期以来一直是严重主动脉瓣狭窄的主要治疗方法。然而，经导管主动脉瓣置换术（TAVR）现在通常被认为是有症状的主动脉瓣狭窄患者的新的护理标准，这些患者不适合开放性手术。可以说，在精心挑选的高风险但仍可手术的患者中，TAVR 也可能是 SAVR 的首选替代方案，这些患者的发病率和死亡率可能降低。尽管 TAVR 的结果不断改善，但仍存在血管损伤、中风、瓣周漏和瓣膜耐久性等方面的问题。然而，随着经导管瓣膜系统、技术和患者选择的不断改进，TAVR 似乎越来越成为更广泛患者的一个有吸引力的选择。随着我们进入微创治疗结构性心脏病的严格临床评估的新时代，随机试验和持续监测将发挥重要作用。
