Department of Cardiology, St. Johannes-Hospital Dortmund, Dortmund, Germany.
Department of Cardiology, University of Bonn, Bonn, Germany.
Surg Technol Int. 2022 May 19;40:221-225. doi: 10.52198/21.STI.40.CV1478.
Since the last decade, transcatheter aortic valve implantation (TAVI) has become the treatment of choice in patients with symptomatic severe aortic stenosis (AS) who are ineligible or at higher risk for surgery. Due to the high safety profile of current device generation, TAVI has emerged as a qualified alternative to surgical aortic valve replacement (SAVR) in patients with classic aortic stenosis and intermediate surgical risk, severe bicuspid aortic valve stenosis, and isolated pure aortic regurgitation. Moderate aortic stenosis, with and without concomitant heart failure with reduced ejection fraction, are under investigation in randomized controlled clinical trials from which we will gain exciting insights on the best timing of TAVI to protect the left ventricle from further functional deterioration due to increasing AS. In these cases, a meticulous diagnostic approach including advanced imaging is becoming more and more important. Current evidence on antithrombotic strategies after TAVI is weak, contributing to poor levels of standardization and high variability in daily clinical practice. This review will provide a short overview of recent clinical trials including best timing for TAVI with moderate AS and antithrombotic strategies after TAVI with current and future TAVI generations.
自上一个十年以来，经导管主动脉瓣植入术（TAVI）已成为症状性重度主动脉瓣狭窄（AS）患者的首选治疗方法，这些患者不适合手术或手术风险较高。由于当前器械的安全性较高，TAVI 已成为经典重度 AS 且手术风险中等、重度二叶式主动脉瓣狭窄以及单纯主动脉瓣反流患者手术主动脉瓣置换术（SAVR）的合格替代方案。中度主动脉瓣狭窄伴或不伴有射血分数降低的心力衰竭正在随机对照临床试验中进行研究，我们将从中获得有关 TAVI 最佳时机的令人兴奋的见解，以防止由于 AS 增加而导致左心室进一步功能恶化。在这些情况下，包括先进成像在内的细致诊断方法变得越来越重要。TAVI 后抗栓策略的现有证据较弱，导致日常临床实践中的标准化程度低且变异性高。这篇综述将简要概述最近的临床试验，包括中度 AS 患者 TAVI 的最佳时机以及当前和未来 TAVI 代的 TAVI 后抗栓策略。
