Division of Cardiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA.
Division of Cardiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
Heart. 2021 Dec;107(24):1938-1941. doi: 10.1136/heartjnl-2021-319179. Epub 2021 Apr 16.
Approximately 2% of people between the ages of 70 and 83 suffer from moderate or greater aortic regurgitation (AR) in the United States. Left untreated, this disease is progressive and fatal; however, up to 8% of patients with AR, who meet the criteria for surgical intervention, do not receive treatment. As such, there is a pressing need to address the lack of treatment options for the thousands of patients with AR who meet a class I indication for aortic valve replacement but who still do not receive surgery. The advent of transcatheter aortic valve implantation (TAVI) has significantly altered the paradigm of treatment for valvular heart disease and is now a well-established therapeutic option for patients with severe aortic stenosis. While transcatheter devices dedicated for the treatment of AR are under investigation, they are not commercially available at this time. Nevertheless, there is a growing body of data that demonstrate acceptable safety and efficacy for the off-label use of current TAVI devices for the treatment of severe AR. Given the dearth of treatment options for inoperable patients with severe AR, available TAVI devices should be considered for this patient population.
在美国,70 至 83 岁人群中约有 2%患有中度或重度主动脉瓣反流(AR)。未经治疗,这种疾病会逐渐恶化并致命;然而,多达 8%的 AR 患者符合手术干预标准,但未接受治疗。因此,迫切需要解决数千名 AR 患者的治疗选择不足的问题,这些患者符合主动脉瓣置换的 I 类适应证,但仍未接受手术。经导管主动脉瓣植入术(TAVI)的出现极大地改变了瓣膜性心脏病的治疗模式,现已成为严重主动脉瓣狭窄患者的一种成熟的治疗选择。虽然专门用于治疗 AR 的经导管装置正在研究中,但目前尚未商业化。然而,越来越多的数据表明,当前 TAVI 装置在治疗严重 AR 时的安全性和有效性可接受。鉴于严重 AR 且无法手术的患者的治疗选择有限,应考虑将现有的 TAVI 装置用于该患者人群。