Galhardo Attílio, Avvedimento Marisa, Mengi Siddhartha, Rodés-Cabau Josep
Quebec Heart & Lung Institute, Laval University, Quebec City, QC G1V 4G5, Canada.
J Clin Med. 2023 Jul 20;12(14):4788. doi: 10.3390/jcm12144788.
Within the last two decades, transcatheter aortic valve replacement (TAVR) has transformed the treatment strategy for symptomatic severe aortic stenosis (AS), representing a less invasive alternative to traditional open-chest surgery. With time, advances in device features, imaging planning, and implantation techniques have contributed to an improvement in safety as well as a reduction in procedural complications. This has led to the expansion of TAVR to lower-risk patients, where TAVR has shown favorable outcomes compared to surgical aortic valve replacement (SAVR). As TAVR expands to younger and lower-risk patients with longer life expectancies, the need for reintervention for failing transcatheter heart valves is expected to increase. Redo-TAVR has gained increasing relevance in the lifetime management of AS as one of the treatment strategies available for structural valve dysfunction (SVD). However, some issues are associated with this approach, including coronary re-access and the risk of coronary obstruction. In this review, we provide essential concepts to properly select candidates for Redo-TAVR, updated data on clinical outcomes and complication rates, and current gaps in evidence.
在过去二十年中，经导管主动脉瓣置换术（TAVR）改变了有症状的重度主动脉瓣狭窄（AS）的治疗策略，成为传统开胸手术的一种侵入性较小的替代方法。随着时间的推移，设备特性、成像规划和植入技术的进步有助于提高安全性并减少手术并发症。这使得TAVR能够扩展到低风险患者，与外科主动脉瓣置换术（SAVR）相比，TAVR在这些患者中显示出良好的效果。随着TAVR扩展到预期寿命更长的年轻和低风险患者，因经导管心脏瓣膜功能衰竭而需要再次干预的情况预计会增加。作为结构性瓣膜功能障碍（SVD）可用的治疗策略之一，再次TAVR在AS的终身管理中越来越重要。然而，这种方法存在一些问题，包括冠状动脉再次进入和冠状动脉阻塞的风险。在这篇综述中，我们提供了正确选择再次TAVR候选者的基本概念、临床结果和并发症发生率的最新数据，以及当前证据方面的差距。
