Agma Hüseyin Umut, Krull Alexandros, Feickert Sebastian, Ammareen Raid Al, Ince Hüseyin, D'Ancona Giuseppe
Department of Cardiology, Internal Medicine and Conservative Intensive Care Medicine, Vivantes Klinikum Am Urban, 10967 Berlin, Germany.
Department of Cardiology, Internal Medicine and Conservative Intensive Care Medicine, Vivantes Klinikum Neukölln, 12351 Berlin, Germany.
Rev Cardiovasc Med. 2022 Oct 17;23(10):349. doi: 10.31083/j.rcm2310349. eCollection 2022 Oct.
Aortic valve stenosis (AVS) is the most frequent valvular heart disease in industrialized countries, presenting with very high mortality if left untreated. While drug treatment can sometimes alleviate symptoms, it fails to stop progression or cure the underlying disease. Until the first decade of this millennium, surgical aortic valve replacement (SAVR) remained the only available therapy option with a positive impact on mortality and morbidity. Even though several studies reported highly positive effects of SAVR regarding the improved quality of life and better physical performance, SAVR remained an intervention that, due to its remarkable complexity and the need for heart-lung machine and cardioplegia, was limited by the patients' comorbid profile. While unsatisfying hemodynamic results after transcatheter aortic balloon valvuloplasty in high-risk surgical patients limited its adoption as an alternative treatment, it provided the impetus for further interventional approaches to the therapy of AVS. This review considers the invention and development of transcatheter aortic valve implantation (TAVI), which established itself as a catheter-based, minimally invasive procedure over the past decade, and has become an equivalent treatment method for high-risk surgical patients. For that matter, early TAVI concepts, their amendments, and the associated pioneers are recognized for paving the way to a revolutionary diversification in AVS treatment.
在工业化国家，主动脉瓣狭窄（AVS）是最常见的心脏瓣膜疾病，若不治疗，死亡率极高。虽然药物治疗有时可缓解症状，但无法阻止病情进展或治愈潜在疾病。在本世纪的第一个十年之前，外科主动脉瓣置换术（SAVR）一直是唯一对死亡率和发病率有积极影响的治疗选择。尽管多项研究报告了SAVR在改善生活质量和提高身体机能方面具有高度积极的效果，但由于其显著的复杂性以及对心肺机和心脏停搏液的需求，SAVR仍然是一种受患者合并症情况限制的干预措施。虽然经导管主动脉球囊瓣膜成形术在高危手术患者中产生的血流动力学结果不尽人意，限制了其作为替代治疗方法的应用，但它为进一步采用介入方法治疗AVS提供了动力。本综述探讨了经导管主动脉瓣植入术（TAVI）的发明与发展，在过去十年中，TAVI已确立为一种基于导管的微创手术，并已成为高危手术患者的等效治疗方法。就此而言，早期的TAVI概念、其改进以及相关的先驱者为AVS治疗带来革命性的多样化铺平了道路而受到认可。
