Horne Aaron, Reineck Elizabeth A, Hasan Rani K, Resar Jon R, Chacko Matthews
Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD.
Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD.
Am Heart J. 2014 Oct;168(4):414-23. doi: 10.1016/j.ahj.2014.07.017. Epub 2014 Jul 28.
Severe aortic stenosis (AS) results in considerable morbidity and mortality without aortic valve replacement and is expected to increase in prevalence with the aging population. Because AS primarily affects the elderly, many patients with comorbidities are poor candidates for surgical aortic valve replacement (SAVR) and may not be referred. Transcatheter aortic valve replacement (TAVR) has emerged as transformative technology for the management of AS over the past decade. Randomized trials have established the safety and efficacy of TAVR with improved mortality and quality of life compared with medical therapy in inoperable patients, while demonstrating noninferiority and even superiority to SAVR among high-risk operative candidates. However, early studies demonstrated an early penalty of stroke and vascular complications with TAVR as well as increased paravalvular leak as compared with SAVR. Two device platforms have been evaluated and approved for use in the United States: the Edwards SAPIEN and the Medtronic CoreValve. Early studies also suggest cost-effectiveness for TAVR. Ongoing studies are evaluating new iterations of the aforementioned TAVR devices, novel device designs, and applications of TAVR in expanded populations of patients including those with lower risk profiles as well as those with comorbidities that were excluded from early clinical trials. Future improvements in TAVR technology will likely reduce periprocedural and long-term complications. Further studies are needed to confirm device durability over long-term follow-up and explore the applicability of TAVR to broader AS patient populations.
重度主动脉瓣狭窄（AS）若不进行主动脉瓣置换，会导致相当高的发病率和死亡率，且随着人口老龄化，其患病率预计还会上升。由于AS主要影响老年人，许多合并其他疾病的患者不适合接受外科主动脉瓣置换术（SAVR），可能无法获得转诊。在过去十年中，经导管主动脉瓣置换术（TAVR）已成为治疗AS的变革性技术。随机试验已证实TAVR的安全性和有效性，与药物治疗相比，它能提高无法手术患者的生存率并改善生活质量，同时在高风险手术候选者中显示出不劣于SAVR甚至优于SAVR的效果。然而，早期研究表明，与SAVR相比，TAVR存在早期中风和血管并发症风险，以及瓣周漏增加的问题。美国已评估并批准了两种设备平台用于临床：爱德华兹SAPIEN和美敦力CoreValve。早期研究还表明TAVR具有成本效益。正在进行的研究正在评估上述TAVR设备的新迭代、新型设备设计，以及TAVR在更广泛患者群体中的应用，包括风险较低的患者以及早期临床试验中排除的合并其他疾病的患者。TAVR技术未来的改进可能会减少围手术期和长期并发症。需要进一步研究以确认设备在长期随访中的耐用性，并探索TAVR在更广泛的AS患者群体中的适用性。
