Tamburino Corrado, Valvo Roberto, Crioscione Enrico, Reddavid Claudia, Picci Andrea, Costa Giuliano, Barbanti Marco
Division of Cardiology, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy.
Eur Heart J Suppl. 2020 Nov 18;22(Suppl L):L140-L145. doi: 10.1093/eurheartj/suaa154. eCollection 2020 Nov.
Aortic stenosis (AS) is one of the most common valvular diseases in developed countries. Transcatheter aortic valve implantation (TAVI) has emerged as alternative to medical treatment or surgical aortic valve replacement (SAVR) in all symptomatic patients with severe AS. In 2002, Cribier performed the first human TAVI through a trans-septal approach in a 57-year-old man with severe AS. Since then, several trials have compared TAVI vs. SAVR over the years. Today, it is superior in terms of mortality to medical therapy in extreme-risk patients, non-inferior or superior to surgery in high-risk patients, and non-inferior to surgery and even superior when transfemoral access is possible in intermediate-risk patients. Interesting results emerged from the latest multicentre trials involving patients with severe AS who were at low risk for death from surgery, demonstrating that this therapy will be offered to younger people in the next future.
主动脉瓣狭窄（AS）是发达国家最常见的瓣膜疾病之一。经导管主动脉瓣植入术（TAVI）已成为所有有症状的重度AS患者替代药物治疗或外科主动脉瓣置换术（SAVR）的选择。2002年，克里比埃通过经房间隔途径为一名57岁的重度AS男性实施了首例人体TAVI。从那时起，多年来已有多项试验对TAVI与SAVR进行了比较。如今，在极高风险患者中，TAVI在死亡率方面优于药物治疗；在高风险患者中，TAVI不劣于或优于手术治疗；在中风险患者中，若可行经股动脉途径，TAVI不劣于手术治疗，甚至更具优势。最新的多中心试验涉及手术死亡风险较低的重度AS患者，得出了有趣的结果，表明在未来这种治疗方法将应用于更年轻的患者。
