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经导管主动脉瓣置换术后心力衰竭。

Heart failure following transcatheter aortic valve replacement.

机构信息

Department of Cardiology, Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.

出版信息

Expert Rev Cardiovasc Ther. 2021 Aug;19(8):695-709. doi: 10.1080/14779072.2021.1949987. Epub 2021 Jul 6.

DOI:10.1080/14779072.2021.1949987
PMID:34227916
Abstract

: Over the past decade, the number of transcatheter aortic valve replacement (TAVR) procedures has increased exponentially. Despite major improvements in both device and successes, the rate of hospital readmission after TAVR remains high, with heart failure (HF) decompensation being one of the most important causes.: This review provides an overview of the current status of HF following TAVR, including details about its incidence, clinical impact, contributing factors, and current and future treatment perspectives.: HF decompensation has been identified as the most common cause of rehospitalization following TAVR, and it has been associated with a negative prognosis. Multiple preexisting factors including low flow status, cardiac amyloidosis, myocardial fibrosis, multivalvular disease, pulmonary hypertension, coronary artery disease, and atrial fibrillation have been associated with an increased risk of HF events. Also, multiple post-procedural factors like the occurrence of significant paravalvular leaks, severe prosthesis-patient mismatch, and conduction disturbances have also contributed to increase this risk . Thus, reducing HF events in TAVR recipients would require a multifactorial and multidisciplinary effort including the optimization of the medical treatment and close follow-up and treatment of residual or concomitant valvular disease and conduction disturbance issues. Future studies in this challenging group of patients are warranted.

摘要

在过去的十年中,经导管主动脉瓣置换术(TAVR)的数量呈指数级增长。尽管设备和成功率都有了重大改进,但 TAVR 后的医院再入院率仍然很高,心力衰竭(HF)失代偿是最重要的原因之一。

这篇综述概述了 TAVR 后 HF 的现状,包括其发病率、临床影响、相关因素以及当前和未来的治疗观点的详细信息。

HF 失代偿是 TAVR 后再住院的最常见原因,与不良预后相关。多种术前因素,包括低流量状态、心脏淀粉样变性、心肌纤维化、多瓣膜疾病、肺动脉高压、冠状动脉疾病和心房颤动,与 HF 事件风险增加相关。此外,多种术后因素,如严重瓣周漏、严重的假体-患者不匹配和传导障碍,也增加了这种风险。因此,减少 TAVR 受者的 HF 事件需要多因素和多学科的努力,包括优化药物治疗以及密切随访和治疗残余或并存的瓣膜疾病和传导障碍问题。未来在这一具有挑战性的患者群体中进行研究是必要的。

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