Barnhart Glenn R, Shrestha Malakh Lal
From the *Department of Cardiac Surgery, Swedish Heart and Vascular Institute, Swedish Medical Center, Seattle, WA USA; and †Department of Cardio-thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Innovations (Phila). 2016 Jan-Feb;11(1):7-14. doi: 10.1097/IMI.0000000000000232.
Aortic stenosis is the most common valvular heart disease in the Western world. It is caused primarily by age-related degeneration and progressive calcification typically detected in patients 65 years and older. In patients presenting with symptoms of heart failure, the average survival rate is only 2 years without appropriate treatment. Approximately one half of all patients die within the first 2 to 3 years of symptom onset. In addition, the age of the patients presenting for aortic valve replacement (AVR) is increased along with the demographic changes. The Society of Thoracic Surgeons (STS) database shows that the number of patients older than 80 years has increased from 12% to 24% during the past 20 years. At the same time, the percentage of candidates requiring AVR as well as concomitant coronary bypass surgery has increased from 5% to 25%. Surgical AVR continues to be the criterion standard for treatment of aortic stenosis, improving survival and quality of life. Recent advances in prosthetic valve technology, such as transcatheter AVR, have expanded the indication for AVR to the extreme high-risk population, and the most recent surgical innovation, rapid deployment AVR, provides an additional tool to the surgeons' armamentarium.
主动脉瓣狭窄是西方世界最常见的心脏瓣膜病。它主要由年龄相关的退变和进行性钙化引起，通常在65岁及以上的患者中检测到。对于出现心力衰竭症状的患者，若不进行适当治疗，平均生存率仅为2年。约一半的患者在症状出现后的头2至3年内死亡。此外，随着人口结构的变化，接受主动脉瓣置换术（AVR）的患者年龄也在增加。胸外科医师协会（STS）数据库显示，在过去20年中，80岁以上患者的数量从12%增加到了24%。与此同时，需要进行AVR以及同期冠状动脉搭桥手术的患者比例从5%增加到了25%。外科AVR仍然是治疗主动脉瓣狭窄的标准方法，可提高生存率和生活质量。人工瓣膜技术的最新进展，如经导管AVR，已将AVR的适应证扩展到极高风险人群，而最新的外科创新——快速部署AVR，为外科医生的器械库增添了一种额外的工具。
