Abdalwahab Ahmed, Omari Muntaser, Alkhalil Mohammad
Cardiothoracic Centre, Freeman Hospital, NE7 7DN Newcastle Upon Tyne, UK.
Cardiovascular Medicine Department, Faculty of Medicine, Tanta University, 31527 Gharbia Governorate, Egypt.
Rev Cardiovasc Med. 2025 Mar 24;26(3):26738. doi: 10.31083/RCM26738. eCollection 2025 Mar.
Over the last two decades, the management of aortic stenosis has undergone significant transformation due to developments in surgical techniques and the introduction of transcatheter aortic valve implantation (TAVI). These transformations have enabled improved patient selection and treatments to be tailored based on individual clinical and anatomical characteristics. Both surgical and transcatheter options have resulted in reduced mortality and enhanced quality of life for patients with aortic stenosis. Nonetheless, treating patients with small aortic annulus remains challenging despite advances in current technology. The insertion of a small prosthetic valve, leading to patient prosthetic mismatch, has been associated with heart failure hospitalization, early structural valve degeneration, and long-term mortality. Although aortic root enlargement was historically employed to address this issue, stentless and sutureless valves in the supra-annular position and, more recently, TAVI have emerged as alternative treatments for patients with small annulus and severe aortic stenosis. This review will provide an overview of the prevalence and anatomical characteristics of patients with aortic stenosis and small annulus. Additionally, we will discuss current treatment options, including surgery and TAVI, used to mitigate procedural and long-term adverse outcomes in this group.
在过去二十年中，由于手术技术的发展以及经导管主动脉瓣植入术（TAVI）的引入，主动脉瓣狭窄的管理发生了重大变革。这些变革使得能够根据个体临床和解剖特征进行更好的患者选择并量身定制治疗方案。手术和经导管治疗方案均降低了主动脉瓣狭窄患者的死亡率并提高了生活质量。尽管如此，尽管当前技术有所进步，但治疗主动脉瓣环小的患者仍然具有挑战性。植入小尺寸人工瓣膜会导致患者人工瓣膜不匹配，这与心力衰竭住院、早期人工瓣膜结构退化和长期死亡率相关。尽管历史上曾采用主动脉根部扩大术来解决这一问题，但瓣环上位置的无支架和无缝线瓣膜以及最近的TAVI已成为瓣环小且严重主动脉瓣狭窄患者的替代治疗方法。本综述将概述主动脉瓣狭窄和瓣环小的患者的患病率及解剖特征。此外，我们将讨论目前用于减轻该组患者手术过程及长期不良结局的治疗选择，包括手术和TAVI。
