Kim Won-Keun, Liebetrau Christoph, van Linden Arnaud, Blumenstein Johannes, Gaede Luise, Hamm Christian W, Walther Thomas, Möllmann Helge
Department of Cardiology, Kerckhoff Heart and Thorax Center, 61231, Bad Nauheim, Germany.
Department of Cardiac Surgery, Kerckhoff Heart and Thorax Center, 61231, Bad Nauheim, Germany.
Clin Res Cardiol. 2016 May;105(5):379-87. doi: 10.1007/s00392-015-0949-6. Epub 2015 Dec 15.
Transcatheter aortic valve implantation (TAVI) has emerged as an important treatment option for elderly patients with symptomatic aortic stenosis whose risk is too high or prohibitive for conventional surgery. Despite notable progress during the past decade, continuous efforts directed at further improvement of procedural safety and performance are required, especially considering expanding indications for interventional treatment options among lower-risk populations. One issue that needs to be addressed is myocardial damage, which can frequently be observed after TAVI and has been linked to worse prognosis. Yet, knowledge concerning the underlying mechanisms and clinical impact remains scarce, and further investigation in this field is warranted. In this review, we provide a contemporary summary of the types of myocardial injury associated with TAVI, including access-related injury, mechanical trauma and ischemia, the role of myocardial biomarkers, and the impact on left ventricular function, with emphasis on potential mechanisms and clinical implications.
经导管主动脉瓣植入术(TAVI)已成为有症状的主动脉瓣狭窄老年患者的一种重要治疗选择,这些患者接受传统手术的风险过高或无法耐受。尽管在过去十年中取得了显著进展,但仍需要持续努力以进一步提高手术安全性和性能,特别是考虑到介入治疗在低风险人群中的适应证不断扩大。一个需要解决的问题是心肌损伤,这在TAVI术后经常可以观察到,并且与较差的预后相关。然而,关于其潜在机制和临床影响的知识仍然匮乏,因此有必要在该领域进行进一步研究。在本综述中,我们对与TAVI相关的心肌损伤类型进行了当代总结,包括与入路相关的损伤、机械创伤和缺血、心肌生物标志物的作用以及对左心室功能的影响,重点关注潜在机制和临床意义。