Leon Martin B, Nikolsky Eugenia
Professor of Medicine, Columbia University College of Physicians and Surgeons, Associate Director, Center for Interventional Vascular Therapy, New York-Presbyterian Hospital/Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY, USA;
Rambam Maimonides Med J. 2010 Oct 31;1(2):e0016. doi: 10.5041/RMMJ.10016. Print 2010 Oct.
Aortic valve replacement (AVR) is a treatment of choice for patients with symptomatic severe aortic stenosis (AS). However, a significant proportion of these patients do not undergo surgical AVR due to high-risk features. Transcatheter aortic valve implantation (TAVI) has emerged as an alternative for patients with severe AS who are not candidates for open-heart surgery. Since the introduction of TAVI to the medical community in 2002, there has been an explosive growth in procedures. The balloon-expandable Edwards SAPIEN valve and the self-expanding CoreValve ReValving(TM) system contribute the largest patient experience with more than 10,000 patients treated with TAVI to date. Clinical outcomes have stabilized in experienced hands, with 30-day mortality less than 10%. Careful patient selection, growing operator experience, and an integrated multidisciplinary team approach contribute to notable improvement in outcomes. In the first randomized pivotal PARTNER trial, in patients with severe AS not suitable candidates for surgical AVR, TAVI compared with standard therapy, significantly improved survival and cardiac symptoms, but was associated with higher incidence of major strokes and major vascular events. The results of randomized comparison of TAVI with AVR among high-risk patients with AS for whom surgery is a viable option are eagerly awaited to provide further evidence on the applicability of TAVI in these patients.
主动脉瓣置换术（AVR）是有症状的重度主动脉瓣狭窄（AS）患者的首选治疗方法。然而，这些患者中有很大一部分因具有高风险特征而未接受外科AVR治疗。经导管主动脉瓣植入术（TAVI）已成为不适宜接受心脏直视手术的重度AS患者的一种替代治疗方法。自2002年TAVI引入医学界以来，手术数量呈爆发式增长。球囊扩张式爱德华兹SAPIEN瓣膜和自膨胀式CoreValve ReValving（TM）系统积累了最多的患者治疗经验，迄今为止已有超过10000例患者接受了TAVI治疗。在经验丰富的医生手中，临床结果已趋于稳定，30天死亡率低于10%。仔细的患者选择、不断增长的术者经验以及多学科综合团队方法有助于显著改善治疗结果。在第一项随机关键PARTNER试验中，对于不适宜接受外科AVR治疗的重度AS患者，TAVI与标准治疗相比，显著提高了生存率并改善了心脏症状，但与较高的严重卒中及重大血管事件发生率相关。人们急切期待着对有手术指征的高危AS患者进行TAVI与AVR随机对照比较的结果，以提供关于TAVI在这些患者中适用性的进一步证据。
