Al-Hawwas Malek, Marmagkiolis Konstantinos, Mehta Jawahar L
Division of Cardiology, Central Arkansas Veterans Healthcare System and the University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Florida Hospital Pepin Heart Institute, Tampa, Florida.
Am J Cardiol. 2017 Oct 1;120(7):1198-1202. doi: 10.1016/j.amjcard.2017.06.066. Epub 2017 Jul 14.
Transcatheter aortic valve implantation (TAVI) appears to be equivalent to surgical aortic valve replacement (SAVR) with regard to clinical end points in high-risk and intermediate risk patients. Major landmark trials, such as Placement of Aortic Transcatheter Valves (PARTNER) trials 1 and 2 and US CoreValve show similar hemodynamic responses and left ventricular remodeling after both procedures. Real-life nonrandomized studies, however, suggest that TAVI may result in a somewhat better hemodynamic response and, therefore, a more favorable left ventricular remodeling than after SAVR for the first few years of follow-up. Further, there are fewer cases of prosthesis patient mismatch and more cases of paravalvular leak and conduction system abnormalities that affect the left ventricular remodeling process with TAVI than with SAVR. Overall, TAVI may be considered superior to SAVR in high-risk patients whose clinical outcome depends on a favorable remodeling process.
对于高危和中危患者的临床终点而言，经导管主动脉瓣植入术（TAVI）似乎等同于外科主动脉瓣置换术（SAVR）。主要的标志性试验，如主动脉经导管瓣膜置入（PARTNER）试验1和试验2以及美国CoreValve试验，显示两种手术术后的血流动力学反应和左心室重构相似。然而，现实生活中的非随机研究表明，在随访的最初几年里，TAVI可能会带来稍好一些的血流动力学反应，因此左心室重构也比SAVR更有利。此外，与SAVR相比，TAVI导致人工瓣膜与患者不匹配的情况较少，而瓣周漏和影响左心室重构过程的传导系统异常情况较多。总体而言，对于临床结局取决于良好重构过程的高危患者，TAVI可能被认为优于SAVR。
