Kalogeropoulos Andreas S, Redwood Simon R, Allen Christopher J, Hurrell Harriet, Chehab Omar, Rajani Ronak, Prendergast Bernard, Patterson Tiffany
St. Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
Department of Cardiology, MITERA General Hospital, Hygeia Healthcare Group, Athens, Greece.
Front Cardiovasc Med. 2022 Nov 21;9:971762. doi: 10.3389/fcvm.2022.971762. eCollection 2022.
Since the first groundbreaking procedure in 2002, transcatheter aortic valve implantation (TAVI) has revolutionized the management of aortic stenosis (AS). Through striking developments in pertinent equipment and techniques, TAVI has now become the leading therapeutic strategy for aortic valve replacement in patients with severe symptomatic AS. The procedure streamlining from routine use of conscious sedation to a single arterial access approach, the newly adapted implantation techniques, and the introduction of novel technologies such as intravascular lithotripsy and the refinement of valve-bioprosthesis devices along with the accumulating experience have resulted in a dramatic reduction of complications and have improved associated outcomes that are now considered comparable or even superior to surgical aortic valve replacement (SAVR). These advances have opened the road to the use of TAVI in younger and lower-risk patients and up-to-date data from landmark studies have now established the outstanding efficacy and safety of TAVI in patients with low-surgical risk impelling the most recent ESC guidelines to propose TAVI, as the main therapeutic strategy for patients with AS aged 75 years or older. In this article, we aim to summarize the most recent advances and the current clinical aspects involving the use of TAVI, and we also attempt to highlight impending concerns that need to be further addressed.
自2002年首次开创性手术以来,经导管主动脉瓣植入术(TAVI)彻底改变了主动脉瓣狭窄(AS)的治疗方式。随着相关设备和技术的显著发展,TAVI现已成为重度症状性AS患者主动脉瓣置换的主要治疗策略。从常规使用清醒镇静到单一动脉入路方法的手术简化、新采用的植入技术、血管内碎石术等新技术的引入以及瓣膜生物假体装置的改进,再加上经验的积累,并发症显著减少,相关预后得到改善,目前认为与外科主动脉瓣置换术(SAVR)相当甚至更优。这些进展为在年轻和低风险患者中使用TAVI开辟了道路,具有里程碑意义的研究的最新数据现已证实TAVI在低手术风险患者中具有卓越的疗效和安全性,促使最新的欧洲心脏病学会(ESC)指南建议将TAVI作为75岁及以上AS患者的主要治疗策略。在本文中,我们旨在总结TAVI使用方面的最新进展和当前临床情况,同时也试图突出需要进一步解决的紧迫问题。