Department of Cardiac, Thoracic and Vascular Science, Padova University Hospital, Via Giustiniani 2, 35128 Padova, Italy.
Mayo Clinic college of Medicine, Rochester, MN, USA.
Eur Heart J. 2018 Feb 21;39(8):658-666. doi: 10.1093/eurheartj/ehx489.
In the last decade, transcatheter aortic valve implantation (TAVI), a disruptive technology, has revolutionized the therapy of symptomatic severe aortic stenosis, and current guidelines state that the recommendations for TAVI and surgical aortic valve replacement (SAVR) are equivalent in patients at high-risk. Increased operator experience, technical advances in the new generation of transcatheter heart valves (THV) and excellent TAVI results in recently published randomized controlled trials have led to the expansion of TAVI indication as an alternative to SAVR in intermediate-risk subjects, given appropriate patient selection. The time is opportune to examine the role of TAVI in low-risk patients, currently the objective of on-going randomized trials. This review aims to summarize the available knowledge on TAVI in low- to intermediate-risk patients and to discuss the potential advantages and pitfalls TAVI will face in this clinical setting.
在过去的十年中，经导管主动脉瓣植入术（TAVI）作为一种颠覆性技术，彻底改变了症状性重度主动脉瓣狭窄的治疗方法，目前的指南指出，在高危患者中，TAVI 和主动脉瓣置换术（SAVR）的推荐是等效的。随着新一代经导管心脏瓣膜（THV）的操作经验增加和技术进步，以及最近公布的随机对照试验中优异的 TAVI 结果，已经导致 TAVI 适应证扩展到中危患者，前提是进行适当的患者选择。现在正是评估 TAVI 在低危患者中的作用的时机，这是目前正在进行的随机试验的目标。本综述旨在总结 TAVI 在低危至中危患者中的现有知识，并讨论 TAVI 在这种临床环境中可能面临的优势和陷阱。
