Kinno Menhel, Cantey Eric P, Rigolin Vera H
Department of Medicine/Division of Cardiology, Northwestern University Feinberg School of Medicine, Bluhm Cardiovascular Institute, 675 N. St Clair St-Suite 19-100, Chicago, IL, 60611, USA.
J Echocardiogr. 2019 Mar;17(1):25-34. doi: 10.1007/s12574-018-0409-1. Epub 2018 Nov 21.
The advent of transcatheter aortic valve replacement (TAVR) has dramatically transformed the clinical approach to severe aortic stenosis. Over the last decade, several trials have shown the equivalence or even superiority of transcatheter valve replacement over the conventional surgical approach. As a result, TAVR as a treatment for severe, symptomatic aortic stenosis has rapidly extended from inoperable or prohibited-risk patients to intermediate-risk patients. The success of TAVR has led to the wide adaptation of this technique and, subsequently, a significant increase in the number of these procedures performed annually. As the number of these procedures is expected to further increase, especially if its indication will include those with low surgical risk, there is a great demand to improve patient recovery and early discharge without compromising outcomes. In this review, we will discuss the role of echocardiography in the perioperative planning and assessment of transcatheter aortic valve replacement. In addition, we will review the current evidence behind the use of intraprocedureal transthoracic echocardiography and the recommended steps for successful transition from transesophageal to transthoracic echocardiography.
经导管主动脉瓣置换术（TAVR）的出现极大地改变了严重主动脉瓣狭窄的临床治疗方法。在过去十年中，多项试验表明经导管瓣膜置换术相对于传统手术方法具有等效性甚至优越性。因此，TAVR作为严重症状性主动脉瓣狭窄的一种治疗方法，已迅速从无法手术或手术风险极高的患者扩展到中度风险患者。TAVR的成功促使该技术得到广泛应用，随后每年进行的此类手术数量大幅增加。由于预计此类手术数量将进一步增加，特别是如果其适应症将包括手术风险较低的患者，因此在不影响治疗效果的前提下，提高患者恢复速度并实现早期出院的需求很大。在本综述中，我们将讨论超声心动图在经导管主动脉瓣置换术围手术期规划和评估中的作用。此外，我们将回顾术中经胸超声心动图使用背后的现有证据以及从经食管超声心动图成功过渡到经胸超声心动图的推荐步骤。
