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[主动脉瓣狭窄:最新进展]

[Aortic stenosis: An update].

作者信息

Guedeney P, Collet J-P

机构信息

Sorbonne université, ACTION Study Group, institut de cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtrière, 47, boulevard de l'hôpital, 75013 Paris, France.

出版信息

Rev Med Interne. 2022 Mar;43(3):145-151. doi: 10.1016/j.revmed.2021.06.003. Epub 2022 Feb 16.

Abstract

Aortic stenosis remains one of the most frequent valvulopathy worldwide, burdened with great mortality and morbidity, and for which there is not yet an effective preventive approach, although the pathophysiological mechanisms involved in its development are better understood nowadays. Its cure, however, has been revolutionized in the last decade by the advent of transcatheter aortic valve implantation, or TAVI (also named transcatheter aortic valve replacement or TAVR). The technique of TAVI has been refined and its indications has been extended, following the publication of large randomized controlled trials where it was compared to surgical aortic valve replacement with favorable results. Consequently, transfemoral TAVR has become the first line of treatment in case of symptomatic severe aortic valve stenosis. In this review, we describe the pathophysiological mechanisms leading to severe aortic stenosis and the main ongoing randomized controlled trials targeting them. We describe the indication for surgical or percutaneous aortic valve replacement and the main complications following the procedure.

摘要

主动脉瓣狭窄仍然是全球最常见的瓣膜病之一,死亡率和发病率极高,尽管目前对其发病的病理生理机制有了更好的理解,但尚未有有效的预防方法。然而,在过去十年中,经导管主动脉瓣植入术(TAVI,也称为经导管主动脉瓣置换术或TAVR)的出现彻底改变了其治疗方式。在大型随机对照试验发表后,TAVI技术得到了改进,其适应证也得到了扩展,这些试验将TAVI与外科主动脉瓣置换术进行了比较,结果良好。因此,经股动脉TAVR已成为有症状的重度主动脉瓣狭窄患者的一线治疗方法。在这篇综述中,我们描述了导致重度主动脉瓣狭窄的病理生理机制以及针对这些机制的主要正在进行的随机对照试验。我们描述了外科或经皮主动脉瓣置换术的适应证以及术后的主要并发症。

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