Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Department of Medicine, Québec Heart and Lung Institute, Laval University, Québec City, Quebec, Canada.
J Am Coll Cardiol. 2022 Aug 2;80(5):527-544. doi: 10.1016/j.jacc.2022.06.001.
A virtual workshop was organized by the Heart Valve Collaboratory to identify areas of expert consensus, areas of disagreement, and evidence gaps related to bioprosthetic aortic valve hemodynamics. Impaired functional performance of bioprosthetic aortic valve replacement is associated with adverse patient outcomes; however, this assessment is complicated by the lack of standardization for labelling, definitions, and measurement techniques, both after surgical and transcatheter valve replacement. Echocardiography remains the standard assessment methodology because of its ease of performance, widespread availability, ability to do serial measurements over time, and correlation with outcomes. Management of a high gradient after replacement requires integration of the patient's clinical status, physical examination, and multimodality imaging in addition to shared patient decisions regarding treatment options. Future priorities that are underway include efforts to standardize prosthesis sizing and labelling for both surgical and transcatheter valves as well as trials to characterize the consequences of adverse hemodynamics.
由心脏瓣膜协作组织组织了一次虚拟研讨会，旨在确定与生物瓣主动脉瓣血流动力学相关的专家共识领域、意见分歧领域和证据空白领域。生物瓣主动脉瓣置换后功能性能受损与患者不良预后相关；然而，由于缺乏标签、定义和测量技术的标准化，无论是在外科手术还是经导管瓣膜置换后，这种评估都变得复杂。由于其易于操作、广泛可用性、随着时间的推移进行连续测量的能力以及与结果的相关性，超声心动图仍然是标准的评估方法。更换后的高梯度管理需要整合患者的临床状况、体格检查和多模态成像，以及患者对治疗选择的共同决策。正在进行的未来优先事项包括努力为外科和经导管瓣膜标准化假体尺寸和标签，以及为描述不良血流动力学后果的试验。
