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[基于导管和手术的主动脉瓣疾病治疗]

[Catheter-based and surgical treatment for aortic valve diseases].

作者信息

Renker Matthias, Charitos Efstratios I, Choi Yeong-Hoon, Sossalla Samuel

机构信息

Abteilung Kardiologie, Kerckhoff-Klinik, Benekestr. 2-8, 61231, Bad Nauheim, Deutschland.

Abteilung Herzchirurgie, Kerckhoff-Klinik, Bad Nauheim, Deutschland.

出版信息

Inn Med (Heidelb). 2024 May;65(5):431-438. doi: 10.1007/s00108-024-01699-y. Epub 2024 Apr 18.

DOI:10.1007/s00108-024-01699-y
PMID:38635087
Abstract

The pathophysiology of aortic valve diseases is of predominantly degenerative nature, characterized by calcific aortic valve stenosis, which is associated with a reduction in prognosis. The prevalence of aortic valve insufficiency also increases with advancing age. Timely causal treatment is crucial in the management of aortic valve diseases. Following the indication for intervention, the heart team plays a central role in evaluating the results and making therapeutic decisions that consider the patient's preferences. In the assessment of treatment options, considerations regarding the long-term perspective are particularly crucial, especially in younger patients. The most common therapeutic approach for aortic valve diseases is the introduction of a new valve prosthesis. In the majority of cases, this is now achieved through catheter-based implantation of a bioprosthetic heart valve, known as transcatheter aortic valve implantation (TAVI). Open surgical aortic valve replacement (AVR) is favored in younger patients with low surgical risk or in the case that TAVI is not feasible. In AVR, both biological and the longest-lasting mechanical prosthesis types are used. Surgical repair techniques are primarily applied in cases of aortic valve regurgitation. Notably, TAVI, as well as surgical procedures for the treatment of aortic valve diseases, have undergone significant advancements in recent years, including expanded indications for TAVI and, on the surgical side, in particular the development of minimally invasive surgical techniques.

摘要

主动脉瓣疾病的病理生理学主要具有退行性本质,其特征为钙化性主动脉瓣狭窄,这与预后降低相关。主动脉瓣关闭不全的患病率也随年龄增长而增加。及时的病因治疗在主动脉瓣疾病的管理中至关重要。在有干预指征后,心脏团队在评估结果和做出考虑患者偏好的治疗决策方面发挥核心作用。在评估治疗方案时,考虑长期观点尤为关键,特别是在年轻患者中。主动脉瓣疾病最常见的治疗方法是植入新的瓣膜假体。在大多数情况下,现在这是通过基于导管的生物人工心脏瓣膜植入来实现的,即经导管主动脉瓣植入术(TAVI)。对于手术风险低的年轻患者或TAVI不可行的情况,开放式外科主动脉瓣置换术(AVR)更受青睐。在AVR中,生物假体和使用时间最长的机械假体类型都会用到。手术修复技术主要应用于主动脉瓣反流的病例。值得注意的是,近年来TAVI以及治疗主动脉瓣疾病的外科手术都取得了重大进展,包括TAVI适应证的扩大,以及在外科方面,特别是微创外科技术的发展。

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[Catheter-based and surgical treatment for aortic valve diseases].[基于导管和手术的主动脉瓣疾病治疗]
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引用本文的文献

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本文引用的文献

1
Transcatheter aortic valve replacement: Past, present, and future.经导管主动脉瓣置换术:过去、现在和未来。
Clin Cardiol. 2024 Jan;47(1):e24209. doi: 10.1002/clc.24209.
2
Design and rationale of the evaluation of transcatheter aortic valve replacement compared to surveillance for patients with asymptomatic severe aortic stenosis: The EARLY TAVR trial.经导管主动脉瓣置换术与无症状重度主动脉瓣狭窄患者监测比较的评估的设计和原理:EARLY TAVR 试验。
Am Heart J. 2024 Feb;268:94-103. doi: 10.1016/j.ahj.2023.11.019. Epub 2023 Dec 4.
3
Transcatheter Aortic-Valve Replacement in Low-Risk Patients at Five Years.
经导管主动脉瓣置换术在五年内的低危患者中的应用。
N Engl J Med. 2023 Nov 23;389(21):1949-1960. doi: 10.1056/NEJMoa2307447. Epub 2023 Oct 24.
4
Transcatheter aortic valve implantation versus surgical aortic valve replacement in patients at low to intermediate surgical risk: rationale and design of the randomised DEDICATE Trial.经导管主动脉瓣植入术与低至中度外科手术风险患者的外科主动脉瓣置换术比较:随机DEDICATE 试验的原理和设计。
EuroIntervention. 2023 Oct 23;19(8):652-658. doi: 10.4244/EIJ-D-23-00232.
5
Combined CT Coronary Artery Assessment and TAVI Planning.联合CT冠状动脉评估与经导管主动脉瓣置入术规划
Diagnostics (Basel). 2023 Apr 3;13(7):1327. doi: 10.3390/diagnostics13071327.
6
2021 ESC/EACTS Guidelines for the management of valvular heart disease.2021年欧洲心脏病学会/欧洲心胸外科学会瓣膜性心脏病管理指南。
Eur Heart J. 2022 Feb 12;43(7):561-632. doi: 10.1093/eurheartj/ehab395.
7
Five-year outcome in 18 010 patients from the German Aortic Valve Registry.18010 例德国主动脉瓣登记研究患者的 5 年结局。
Eur J Cardiothorac Surg. 2021 Nov 2;60(5):1139-1146. doi: 10.1093/ejcts/ezab216.
8
A Y Incision and Rectangular Patch to Enlarge the Aortic Annulus by Three Valve Sizes.A Y 型切口和矩形补片使主动脉瓣环扩大三个瓣口面积。
Ann Thorac Surg. 2021 Aug;112(2):e139-e141. doi: 10.1016/j.athoracsur.2021.01.072. Epub 2021 Mar 6.
9
Coronary Cannulation After Transcatheter Aortic Valve Replacement: The RE-ACCESS Study.经导管主动脉瓣置换术后的冠状动脉插管:RE-ACCESS 研究。
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10
Choice of transcatheter heart valve: should we select the device according to each patient's characteristics or should it be "one valve fits all"?经导管心脏瓣膜的选择:我们应该根据每位患者的特征来选择器械,还是应该采用“一种瓣膜适用于所有人”的方式?
Ann Transl Med. 2020 Aug;8(15):961. doi: 10.21037/atm.2020.04.13.