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低风险年轻人群中的经导管主动脉瓣置换术:一把双刃剑?

Transcatheter aortic valve replacement in low-risk young population: A double edge sword?

作者信息

Bhogal Sukhdeep, Batta Akash

机构信息

Department of Cardiology, Sovah Health, Martinsville, VA 24112, United States.

Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana 141001, India.

出版信息

World J Cardiol. 2024 Apr 26;16(4):177-180. doi: 10.4330/wjc.v16.i4.177.

Abstract

Since the advent of transcatheter aortic valve replacement (TAVR) in 2002, it has now become the default interventional strategy for symptomatic patients presenting with severe aortic stenosis, particularly in intermediate to high-surgical risk patients. In 2019, the United States Food and Drug Administration approved TAVR in low-risk patients based on two randomized trials. However, these breakthrough trials excluded patients with certain unfavorable anatomies and odd profiles. While currently there is no randomized study of TAVR in young patients, it may be preferred by the young population given the benefits of early discharge, shorter hospital stay, and expedite recovery. Nonetheless, it is important to ruminate various factors including lifetime expectancy, risk of pacemaker implantation, and the need for future valve or coronary interventions in young cohorts before considering TAVR in these patients. Furthermore, the data on long-term durability (> 10 years) of TAVR is still unknown given most of the procedures were initially performed in the high or prohibitive surgical risk population. Thus, this editorial aims to highlight the importance of considering an individualized approach in young patients with consideration of various factors including lifetime expectancy while choosing TAVR against surgical aortic valve replacement.

摘要

自2002年经导管主动脉瓣置换术(TAVR)问世以来,它现已成为有症状的重度主动脉瓣狭窄患者的默认介入治疗策略,尤其是在手术风险中到高的患者中。2019年,美国食品药品监督管理局基于两项随机试验批准了TAVR用于低风险患者。然而,这些突破性试验排除了某些解剖结构不利和情况特殊的患者。虽然目前尚无针对年轻患者的TAVR随机研究,但鉴于早期出院、住院时间短和恢复快等益处,年轻人群可能更倾向于选择TAVR。尽管如此,在考虑对这些年轻患者进行TAVR之前,仔细思考各种因素,包括预期寿命、起搏器植入风险以及未来瓣膜或冠状动脉干预的必要性,是很重要的。此外,鉴于大多数手术最初是在手术风险高或极高的人群中进行的,TAVR长期耐用性(>10年)的数据仍然未知。因此,这篇社论旨在强调在年轻患者中选择TAVR而非外科主动脉瓣置换术时,考虑包括预期寿命在内的各种因素并采取个体化方法的重要性。

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本文引用的文献

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