From the Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands (M.A.); and International Centre for Circulatory Health, NHLI, Imperial College London, United Kingdom (P.W.S.).
Circ Cardiovasc Interv. 2016 Apr;9(4):e002944. doi: 10.1161/CIRCINTERVENTIONS.115.002944.
Transcatheter aortic valve implantation underwent progressive improvements until it became the default therapy for inoperable patients, and a recommended therapy in high-risk operable patients with symptomatic severe aortic stenosis. In the lower-risk patient strata, a currently costly therapy that still has important complications with questionable durability is competing with the established effective and still-improving surgical replacement. This report tries to weigh the clinical evidence, the recent technical improvements, the durability, and the cost-effectiveness claims supporting the adoption of transcatheter aortic valve implantation in intermediate-low risk patients. The importance of appropriate patients' risk stratification and a more comprehensive approach to estimate that risk are also emphasized in the present report.
经导管主动脉瓣植入术不断改进，直至成为手术禁忌的患者的首选治疗方法，以及高危可手术的有症状重度主动脉瓣狭窄患者的推荐治疗方法。在低危患者人群中，一种目前费用较高且仍存在重要并发症、耐久性存在疑问的治疗方法正在与已确立的有效且仍在不断改进的手术置换竞争。本报告旨在权衡支持在中低危风险患者中采用经导管主动脉瓣植入术的临床证据、最近的技术改进、耐久性和成本效益主张。本报告还强调了对合适患者进行风险分层和采用更全面方法来评估该风险的重要性。
