Department of Cardiology, Memorial Ankara Hospital, Ankara, Turkey.
Department of Cardiovascular Surgery, Shalamar Medical & Dental College, Lahore, Pakistan.
Acta Cardiol. 2021 Nov;76(9):921-932. doi: 10.1080/00015385.2020.1858250. Epub 2020 Dec 11.
Mechanical valves and bioprosthetic heart valves are widely used for aortic valve replacement (AVR). Mechanical valves are associated with risk of bleeding because of oral anticoagulation, while the durability and structural valve deterioration (SVD) represent the main limitation of the bioprosthetic heart valves. The implantation of bioprosthetic heart valves is increasing precipitously due aging population, and the widespread use of transcatheter aortic valve replacement (TAVR). TAVR has become the standard treatment for intermediate or high surgical risk patients and a reasonable alternative to surgery for low risk patients with symptomatic severe aortic stenosis. Moreover, TAVR is increasingly being used for younger and lower-risk patients with longer life expectancy; therefore it is important to ensure the valve durability for long-term transcatheter aortic valves. Although the results of mid-term durability of the transcatheter heart valves are encouraging, their long-term durability remains largely unknown. This review summarises the definitions, mechanisms, risk factors and assessment of SVD; overviews available data on surgical bioprosthetic and transcatheter heart valves durability.
机械瓣膜和生物瓣被广泛应用于主动脉瓣置换术(AVR)。由于需要口服抗凝药物,机械瓣膜会增加出血风险,而生物瓣的耐久性和结构瓣衰败(SVD)是其主要的局限性。由于人口老龄化和经导管主动脉瓣置换术(TAVR)的广泛应用,生物瓣的植入数量迅速增加。TAVR 已成为中高危手术风险患者的标准治疗方法,也是有症状的严重主动脉瓣狭窄低危患者手术治疗的合理替代方法。此外,TAVR 也越来越多地用于预期寿命较长的年轻和低危患者;因此,确保长期经导管主动脉瓣的耐久性非常重要。尽管经导管心脏瓣膜的中期耐久性结果令人鼓舞,但它们的长期耐久性在很大程度上仍不清楚。这篇综述总结了 SVD 的定义、机制、风险因素和评估;概述了关于外科生物瓣和经导管心脏瓣膜耐久性的现有数据。
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