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主动脉瓣置换术:我们是否面临过多选择?

Aortic Valve Replacement: Are We Spoiled for Choice?

作者信息

Bashir Mohamad, Harky Amer, Bleetman David, Adams Benjamin, Roberts Neil, Balmforth Damian, Yap John, Lall Kulvinder, Shipolini Alex, Oo Aung, Uppal Rakesh

机构信息

Department of Cardiothoracic Surgery, St Bartholomew's Hospital, London, UK.

Department of Cardiothoracic Surgery, St Bartholomew's Hospital, London, UK.

出版信息

Semin Thorac Cardiovasc Surg. 2017;29(3):265-272. doi: 10.1053/j.semtcvs.2017.08.003. Epub 2017 Aug 18.

Abstract

Management of aortic valve disease and, in particular, aortic valve stenosis has evolved through the course of time from medical management and balloon valvuloplasty to the presumed gold-standard surgical intervention. However, with the advent of surgical innovation, intra- and postoperative patients monitoring, understanding of hemodynamic dysfunction, and choices of prosthesis, conventional surgical aortic valve replacements are currently being challenged in particular in moderate- and high-risk patients. Although the long-term results and survival are not robustly available, the durability of the new prosthesis, repair, and the freedom from reoperation remain debatable. In this review, we aim to highlight the surgical innovation attained, choices of aortic valve prosthesis, and also dwell on the current evidence, practice, and trend steered to managing patients with aortic valve stenosis.

摘要

主动脉瓣疾病的管理,尤其是主动脉瓣狭窄的管理,随着时间的推移已从药物治疗和球囊瓣膜成形术发展到被认为是金标准的外科手术干预。然而,随着外科创新、术中和术后患者监测、对血流动力学功能障碍的理解以及假体选择的出现,传统的外科主动脉瓣置换术目前正面临挑战,尤其是在中高危患者中。尽管长期结果和生存率尚无确凿数据,但新型假体、修复的耐久性以及再次手术的自由度仍存在争议。在本综述中,我们旨在强调已取得的外科创新、主动脉瓣假体的选择,并探讨目前用于管理主动脉瓣狭窄患者的证据、实践和趋势。

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