Cahill Thomas J, Terre Juan A, George Isaac
Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, NY, USA.
Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
Ann Cardiothorac Surg. 2020 Nov;9(6):442-451. doi: 10.21037/acs-2020-av-24.
The management of aortic stenosis has been revolutionized by transcatheter aortic valve replacement (TAVR). Initially only undertaken in patients at prohibitive or high surgical risk, as the evidence base and indications have expanded, TAVR is now approved and undertaken in patients at all risk levels. Evolution of valve technology, delivery systems and pathways for patient work-up have been rapid, with associated reductions in the complication profile, particularly vascular complications. Challenges remain as TAVR continues to advance, however, specifically achieving further reduction in paravalvular regurgitation, the requirement for permanent pacemaker implantation, and balancing the risks of thrombosis and bleeding. In this review, we outline the historical advances leading to contemporary TAVR practice, and discuss the future trajectory.
经导管主动脉瓣置换术（TAVR）彻底改变了主动脉瓣狭窄的治疗方式。最初，该手术仅针对手术风险极高或无法进行手术的患者进行，随着证据基础的扩大和适应症的增加，如今TAVR已获批用于所有风险级别的患者。瓣膜技术、输送系统以及患者术前检查流程都在迅速发展，并发症发生率，尤其是血管并发症有所降低。然而，随着TAVR的不断发展，挑战依然存在，特别是如何进一步减少瓣周反流、永久起搏器植入的需求，以及平衡血栓形成和出血的风险。在本综述中，我们概述了促成当代TAVR实践的历史进展，并讨论了未来的发展轨迹。
