Beerkens Frans J, Tang Gilbert H L, Kini Annapoorna S, Lerakis Stamatios, Dangas George D, Mehran Roxana, Khera Sahil, Goldman Martin, Fuster Valentin, Bhatt Deepak L, Webb John G, Sharma Samin K
Mount Sinai Fuster Heart Hospital, New York, New York, USA.
Mount Sinai Fuster Heart Hospital, New York, New York, USA; Department of Cardiovascular Surgery, Mount Sinai Health System, New York, New York, USA.
J Am Coll Cardiol. 2025 Mar 11;85(9):944-964. doi: 10.1016/j.jacc.2024.11.051.
Transcatheter aortic valve replacement (TAVR) has become the preferred treatment option in appropriate patients with symptomatic severe aortic stenosis (AS). A number of advancements have since expanded the eligible population to bicuspid aortic valve with feasible anatomy; small aortic annuli; low-flow, low-gradient AS; and younger patients. Focus has also shifted beyond the symptomatic severe patients to asymptomatic severe and moderate AS, as early valve replacement may prevent irreversible cardiac remodeling. Dedicated devices to treat native aortic regurgitation have shown encouraging short-term outcomes. While the expansion of TAVR to younger patients has raised questions about valve durability and feasibility of reintervention, valve-in-valve TAVR has thus far shown encouraging midterm results. In this review, we summarize the evidence in these contemporary TAVR populations, exploring both the promise and challenge of broadening the patient pool for this minimally invasive procedure.
经导管主动脉瓣置换术（TAVR）已成为有症状的重度主动脉瓣狭窄（AS）患者的首选治疗方案。此后，一系列进展将符合条件的人群扩大到具有可行解剖结构的二叶式主动脉瓣、小主动脉瓣环、低流量、低梯度AS以及年轻患者。关注点也已从有症状的重度患者转移到无症状的重度和中度AS患者，因为早期瓣膜置换可能预防不可逆的心脏重塑。用于治疗原发性主动脉瓣反流的专用器械已显示出令人鼓舞的短期疗效。虽然将TAVR扩展到年轻患者引发了关于瓣膜耐久性和再次干预可行性的问题，但迄今为止，瓣中瓣TAVR已显示出令人鼓舞的中期结果。在本综述中，我们总结了这些当代TAVR人群中的证据，探讨了扩大这一微创手术患者群体的前景和挑战。
