Nguyen Quynh, Luc Jessica Gy, MacGillivray Thomas E, Preventza Ourania A
Faculty of Medicine and Dentistry, University of Alberta Edmonton, Canada.
Division of Cardiovascular Surgery, Department of Surgery, University of British Columbia Vancouver, Canada.
US Cardiol. 2022 Jul 21;16:e18. doi: 10.15420/usc.2022.08. eCollection 2022.
Aortic stenosis is a common form of acquired degenerative valvular disease associated with poor survival after the onset of symptoms. Treatment options for patients with aortic stenosis in addition to medical therapy include surgical aortic valve replacement (SAVR) with either tissue or mechanical valves, or transcatheter aortic valve replacement (TAVR) with either balloon-expandable or self-expanding valves via either transfemoral or alternative access routes. In this review, the authors discuss the current evidence and special considerations regarding the use of TAVR versus SAVR in the management of severe aortic stenosis in young (<65 years of age), low-risk patients, highlighting the history of aortic stenosis treatment, the current guidelines and recommendations, and important issues that remain to be addressed. Ultimately, until ongoing clinical trials with long-term follow-up data shed light on whether interventions for aortic stenosis can be broadened to a low-risk population, TAVR in young, low-risk patients should be undertaken with caution and with guidance from a multidisciplinary heart team.
主动脉瓣狭窄是一种常见的获得性退行性瓣膜疾病,症状出现后生存率较低。除药物治疗外,主动脉瓣狭窄患者的治疗选择包括使用生物瓣或机械瓣进行外科主动脉瓣置换术(SAVR),或通过经股动脉或其他入路途径,使用球囊扩张瓣或自膨胀瓣进行经导管主动脉瓣置换术(TAVR)。在本综述中,作者讨论了在年轻(<65岁)、低风险患者的严重主动脉瓣狭窄管理中,使用TAVR与SAVR的现有证据和特殊考虑因素,重点介绍了主动脉瓣狭窄治疗的历史、当前指南和建议,以及仍有待解决的重要问题。最终,在有长期随访数据的正在进行的临床试验阐明主动脉瓣狭窄干预措施是否可扩大到低风险人群之前,年轻、低风险患者的TAVR应谨慎进行,并在多学科心脏团队的指导下进行。