Sheng Wenjing, Zhu Qifeng, Dai Hanyi, Zhou Dao, Liu Xianbao
Department of Cardiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, State Key Laboratory of Transvascular Implantation Devices, Hangzhou 310009, China.
Zhejiang Provincial Key Laboratory of Cardiovascular Disease Diagnosis and Treatment, Hangzhou 310009, China.
Zhejiang Da Xue Xue Bao Yi Xue Ban. 2025 Mar 25;54(2):154-160. doi: 10.3724/zdxbyxb-2024-0391.
Transcatheter aortic valve replacement (TAVR) has emerged as the standard treatment for severe aortic stenosis, demonstrating comparable efficacy to traditional surgery in low and intermediate-risk patients. However, the bioprosthetic valves utilized in TAVR have a limited lifespan, and bioprosthetic valve failure, including calcification, rupture or infection may develop, leading to poor clinical outcomes. Elevated blood pressure has been identified as a key factor in aortic valve calcification, and its role in bioprosthetic valve failure is gaining increasing attention. Hypertension may accelerate the calcification process and exacerbate valve failure due to increased mechanical stress on the valve, activation of the renin-angiotensin system, and enhanced thrombus formation. Furthermore, elevated blood pressure interacts with prosthesis mismatch and paravalvular leak, jointly affecting valve durability. This review explores the impact of elevated blood pressure on bioprosthetic valve calcification and failure after TAVR, and emphasizes the importance of blood pressure control, optimized preoperative assessment, and appropriate valve selection in reducing valve failures.
经导管主动脉瓣置换术（TAVR）已成为重度主动脉瓣狭窄的标准治疗方法，在低风险和中度风险患者中显示出与传统手术相当的疗效。然而，TAVR中使用的生物瓣膜寿命有限，可能会出现生物瓣膜功能障碍，包括钙化、破裂或感染，导致临床预后不佳。血压升高已被确认为主动脉瓣钙化的关键因素，其在生物瓣膜功能障碍中的作用日益受到关注。高血压可能会加速钙化过程，并由于瓣膜上机械应力增加、肾素-血管紧张素系统激活和血栓形成增加而加剧瓣膜功能障碍。此外，血压升高与人工瓣膜不匹配和瓣周漏相互作用，共同影响瓣膜耐久性。本综述探讨了血压升高对TAVR术后生物瓣膜钙化和功能障碍的影响，并强调了血压控制、优化术前评估和适当瓣膜选择在减少瓣膜功能障碍方面的重要性。
