Siddique Saima, Khanal Resha, Vora Amit N, Gada Hemal
University of Pittsburgh Medical Center Heart and Vascular Institute Harrisburg, PA.
Duke University Medical Center Durham, NC.
US Cardiol. 2022 Apr 14;16:e10. doi: 10.15420/usc.2021.24. eCollection 2022.
As transcatheter aortic valve replacement (TAVR) rapidly expands to younger patients and those at low surgical risk, there is a compelling need to identify patients at increased risk of post-procedural complications, such as paravalvular leak, prosthesis-patient mismatch, and conduction abnormalities. This review highlights the incidence and risk factors of these procedural complications, and focuses on novel methods to reduce them by using newer generation transcatheter heart valves and the innovative cusp-overlap technique, which provides optimal fluoroscopic imaging projection to allow for precise implantation depth which minimizes interaction with the conduction system. Preserving coronary access after TAVR is another important consideration in younger patients. This paper reviews the significance of commissural alignment to allow coronary cannulation after TAVR and discusses recently published data on modified delivery techniques to improve commissural alignment.
随着经导管主动脉瓣置换术（TAVR）迅速扩展至年轻患者以及手术风险较低的患者，迫切需要识别术后并发症风险增加的患者，如瓣周漏、人工瓣膜-患者不匹配和传导异常。本综述强调了这些手术并发症的发生率和风险因素，并重点介绍了通过使用新一代经导管心脏瓣膜和创新的瓣叶重叠技术来降低并发症的新方法，该技术可提供最佳的荧光透视成像投影，以实现精确的植入深度，从而减少与传导系统的相互作用。在年轻患者中，TAVR术后保留冠状动脉通路是另一个重要考虑因素。本文综述了瓣叶对齐对于TAVR术后冠状动脉插管的重要性，并讨论了最近发表的关于改进输送技术以改善瓣叶对齐的数据。
