Bianchi Renatomaria, Cappelli Bigazzi Maurizio, Salerno Gemma, Tartaglione Donato, Ciccarelli Giovanni, Golino Paolo
U.O.C. Cardiologia "Luigi Vanvitelli", AORN dei Colli Monaldi, Napoli.
G Ital Cardiol (Rome). 2020 Nov;21(11 Suppl 1):17S-25S. doi: 10.1714/3487.34669.
During transcatheter aortic valve implantation (TAVI) the native valve is not removed but crushed. Thus, a slight prosthesis insufficiency is not uncommon and has been reported up to 25% of patients for both available types of percutaneous valves. However, the definition of "clinically significant" valve regurgitation is not fully established yet. In most cases, aortic insufficiency is mild and clinical acceptable; however, severe insufficiency can occur. Paravalvular insufficiency is usually prevalent, and it may be the consequence of prosthesis-patient mismatch due to an undersizing of the implanted device or an incomplete expansion of the prosthesis stent frame, or also to incorrect site of prosthesis implantation. Thus, accurate assessment of the aortic valve annulus before TAVI is mandatory in order to select the optimal valve size. The presence of large calcium burden or bicuspid valve as well as the correct implantation of the device are other key determinants of final valve insufficiency. When severe regurgitation is present, an integration of hemodynamic, angiographic, transthoracic and transesophageal echocardiography data is necessary to tailor the best clinical decision on a per-patient basis.
在经导管主动脉瓣植入术（TAVI）过程中，原生瓣膜并非被移除，而是被挤压。因此，轻微的人工瓣膜功能不全并不罕见，据报道，两种可用类型的经皮瓣膜在高达25%的患者中都出现过这种情况。然而，“具有临床意义的”瓣膜反流的定义尚未完全确立。在大多数情况下，主动脉瓣关闭不全是轻度的，临床上可以接受；然而，也可能出现严重的关闭不全。瓣周漏通常较为普遍，它可能是由于植入装置尺寸过小、人工瓣膜支架框架扩张不完全，或者人工瓣膜植入位置不正确导致的人工瓣膜与患者不匹配的结果。因此，在TAVI之前准确评估主动脉瓣环对于选择最佳瓣膜尺寸至关重要。大量钙化或二叶式瓣膜的存在以及装置的正确植入是最终瓣膜功能不全的其他关键决定因素。当出现严重反流时，需要综合血流动力学、血管造影、经胸和经食管超声心动图数据，以便根据每位患者的情况做出最佳临床决策。
