Jakulla Roopesh Sai, Gunta Satya Preetham, Huded Chetan P
Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO 64110, USA.
Department of Cardiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
J Clin Med. 2023 Sep 19;12(18):6048. doi: 10.3390/jcm12186048.
Severe aortic stenosis (AS) carries a poor prognosis with the onset of heart failure (HF) symptoms, and surgical or transcatheter aortic valve replacement (AVR) is its only definitive treatment. The management of AS has seen a paradigm shift with the adoption of transcatheter aortic valve replacement (TAVR), allowing for the treatment of AS in patients who would not otherwise be candidates for surgical AVR. Despite improving long-term survival after TAVR in recent years, residual HF symptoms and HF hospitalization are common and are associated with an increased mortality and a poor health status. This review article summarizes the incidence and risk factors for HF after AVR. Strategies for preventing and better managing HF after AVR are necessary to improve outcomes in this patient population. Extensive research is underway to assess whether earlier timing for AVR, prior to the development of severe symptomatic AS and associated extra-valvular cardiac damage, can improve post-AVR patient outcomes.
重度主动脉瓣狭窄（AS）一旦出现心力衰竭（HF）症状，预后较差，而外科手术或经导管主动脉瓣置换术（AVR）是其唯一的确定性治疗方法。随着经导管主动脉瓣置换术（TAVR）的采用，AS的治疗模式发生了转变，使得原本不适合接受外科AVR的患者也能接受AS治疗。尽管近年来TAVR术后患者的长期生存率有所提高，但HF残余症状和HF住院情况仍很常见，且与死亡率增加及健康状况不佳有关。本文综述总结了AVR术后HF的发生率及危险因素。为改善该患者群体的预后，有必要采取预防和更好地管理AVR术后HF的策略。目前正在进行广泛研究，以评估在严重症状性AS及相关瓣膜外心脏损害出现之前更早进行AVR，是否能改善AVR术后患者的预后。
