Ahmad Khansa, Mentias Amgad, Imran Hafiz, Elbadawi Ayman, Hyder Omar, Gordon Paul, Sharaf Barry, Saad Marwan
Department of Medicine, Division of Cardiology, Alpert Medical School of Brown University, Providence, RI 02903, USA.
Lifespan Cardiovascular Institute, Providence, RI 02903, USA.
Rev Cardiovasc Med. 2023 Feb 6;24(2):49. doi: 10.31083/j.rcm2402049. eCollection 2023 Feb.
Since its food and drug administration (FDA) approval in 2011, transcatheter aortic valve replacement (TAVR) has revolutionized the highly prevalent disease of aortic stenosis. In this review, we present a comprehensive overview of the data and considerations for utilization of TAVR in special populations who were either excluded from or not adequately represented in the seminal TAVR trials, due to high-risk valvular and/or systemic factors. These include nonagenarians, patients with renal dysfunction, chronic thrombocytopenia, bicuspid aortic valve, rheumatic valve disease, patients with failed aortic valve bioprosthesis requiring valve-in-valve intervention and patients with mixed aortic valve disease. In short, TAVR is a feasible therapeutic strategy in high-risk and special populations with mortality benefit and improvement in quality of life. Randomized controlled trials in high-risk populations are recommended to confirm results from observational studies.
自2011年获得美国食品药品监督管理局（FDA）批准以来，经导管主动脉瓣置换术（TAVR）彻底改变了主动脉瓣狭窄这种高度常见的疾病。在本综述中，我们全面概述了由于高风险瓣膜和/或全身因素而被排除在开创性TAVR试验之外或在这些试验中未得到充分体现的特殊人群使用TAVR的数据和注意事项。这些人群包括九旬老人、肾功能不全患者、慢性血小板减少症患者、二叶式主动脉瓣患者、风湿性瓣膜病患者、需要瓣中瓣介入治疗的主动脉瓣生物假体功能失效患者以及混合性主动脉瓣疾病患者。简而言之，TAVR对于高风险和特殊人群是一种可行的治疗策略，具有降低死亡率和改善生活质量的益处。建议在高风险人群中开展随机对照试验以证实观察性研究的结果。
