Niglio T, Galasso G, Piccolo R, Di Gioia G, Strisciuglio T, Esposito G, Trimarco B, Piscione F
Department of Advanced Biomedical Sciences Federico II University, Naples, Italy -
Minerva Cardioangiol. 2014 Apr;62(2):193-203.
To date, the gold standard of aortic stenosis treatment is surgical valve replacement. However, in inoperable or high risk patients a valid alternative is transcatheter aortic valve implantation (TAVI). Several trials showed feasibility, efficacy and safety of TAVI, with a tailored strategy for these patients on the basis of their clinical and anatomical conditions. The selection of valve type (CoreValve® or Edwards Sapien®) and transcatheter approach (transfemoral, transapical, subclavian or direct aortic approach) is an important step in the management of aortic stenosis. However, mortality is high and it is mainly related to non-cardiac reasons, given the high clinical risk profile of these patients. Moreover, the less invasive approach, the faster recovery, the reduced morbidity and the improved psychological tolerance, typical of TAVI, suggest that this technique could be used in a broader spectrum of cases, becoming a valid therapeutic alternative even in patients with severe aortic stenosis with a low surgical risk or asymptomatics. The identification of aortic stenosis patients by the medical community and their assessment over time, before they become candidates only for "extreme" strategies, remains the main challenge.
迄今为止，主动脉瓣狭窄治疗的金标准是外科瓣膜置换术。然而，对于无法进行手术或手术风险高的患者，经导管主动脉瓣植入术（TAVI）是一种有效的替代方法。多项试验表明了TAVI的可行性、有效性和安全性，并根据这些患者的临床和解剖状况为其制定了个性化策略。瓣膜类型（CoreValve®或Edwards Sapien®）和经导管入路（经股动脉、经心尖、经锁骨下动脉或直接主动脉入路）的选择是主动脉瓣狭窄管理中的重要一步。然而，鉴于这些患者的临床风险较高，死亡率很高，且主要与非心脏原因有关。此外，TAVI具有侵入性较小、恢复更快、发病率降低以及心理耐受性改善等特点，这表明该技术可用于更广泛的病例，甚至在手术风险低或无症状的严重主动脉瓣狭窄患者中也成为一种有效的治疗选择。医学界对主动脉瓣狭窄患者的识别以及在他们仅成为“极端”策略的候选者之前对其进行长期评估，仍然是主要挑战。
