Banovic Marko, Iung Bernard, Wojakowski Wojtek, Van Mieghem Nicholas, Bartunek Jozef
Belgrade Medical Faculty, University of Belgrade, Belgrade, Serbia.
Cardiology Department, University Clinical Center of Serbia, Belgrade, Serbia.
Struct Heart. 2023 Jun 27;7(5):100201. doi: 10.1016/j.shj.2023.100201. eCollection 2023 Sep.
Over the last decades, we have witnessed considerable improvements in diagnostics and risk stratification of patients with significant aortic stenosis (AS), paralleled by advances in operative and anesthetic techniques. In addition, accumulating evidence points to the potential benefit of early valve replacement in such patients prior to the onset of symptoms. In parallel, interventional randomized trials have proven the benefit of transcatheter aortic valve replacement in comparison to a surgical approach to valve replacement over a broad risk spectrum in symptomatic patients with AS. This article reviews contemporary management approaches and scrutinizes open questions regarding timing and mode of intervention in asymptomatic patients with severe AS. We also discuss the challenges surrounding the management of symptomatic patients with moderate AS as well as emerging dilemmas related to the concept of a life-long treatment strategy for patients with AS.
在过去几十年里，我们见证了重度主动脉瓣狭窄（AS）患者的诊断和风险分层有了显著改善，同时手术和麻醉技术也取得了进步。此外，越来越多的证据表明，在此类患者出现症状之前尽早进行瓣膜置换可能有益。与此同时，介入性随机试验已证明，对于有症状的AS患者，在广泛的风险范围内，经导管主动脉瓣置换术相较于外科瓣膜置换术具有优势。本文回顾了当代的管理方法，并审视了关于无症状重度AS患者干预时机和方式的未决问题。我们还讨论了有症状中度AS患者管理方面的挑战，以及与AS患者终身治疗策略概念相关的新困境。
