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[经导管主动脉瓣置换术后结构性瓣膜退化:研究进展]

[Structural valve deterioration after transcatheter aortic valve replacement: a research update].

作者信息

Yan Mengyun, Zhao Zhengang, Chen Mao

机构信息

Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, China.

出版信息

Zhejiang Da Xue Xue Bao Yi Xue Ban. 2025 Mar 25;54(2):183-190. doi: 10.3724/zdxbyxb-2024-0470.


DOI:10.3724/zdxbyxb-2024-0470
PMID:40304105
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12062941/
Abstract

Structural valve deterioration (SVD) refers to intrinsic and irreversible pathological changes in the components of prosthetic heart valves, manifesting as fibrosis, calcification, wear and tear, loosening, as well as strut fracture or deformation of the valve framework. These changes ultimately lead to valve stenosis and/or regurgitation.The mechanisms may be related to mechanical stress, immune response and abnormal calcium-phosphorus metabolism. Studies have shown that risk factors for SVD include patient factors (such as age, underlying cardiovascular disease and comorbidities), valve factors (such as material properties, processing techniques, and valve type), and surgical factors (such as valve injury, suboptimal stent expansion, and irregular stent release morphology). Clinical imaging assessment of SVD demonstrates complementary advantages among echocardiography, multi-detector spiral CT and cardiac magnetic resonance imaging, with distinct diagnostic objectives. The primary management strategies for SVD after trans-catheter aortic valve replacement (TAVR) include drug therapy, redo-TAVR, surgical aortic valve replacement (SAVR) and the novel SURPLUS technique. Among them, redo-TAVR has become a common method because of its minimally invasive nature, but it is still necessary to further clarify the patient indications and optimize the surgical strategy. SAVR is reserved for young, low-risk patients; SURPLUS combines the advantages of SAVR and TAVR, making it suitable for cases where redo-TAVR is unfeasible or contraindicated, while the risk of SAVR is excessively high. This article reviews the latest progress of SVD following TAVR treatment to provide reference for research into the durability of bioprosthetic valve and clinical intervention of SVD.

摘要

结构性瓣膜退变(SVD)是指人工心脏瓣膜组件发生的内在且不可逆的病理变化,表现为纤维化、钙化、磨损、松动以及瓣膜支架骨折或变形。这些变化最终导致瓣膜狭窄和/或反流。其机制可能与机械应力、免疫反应及钙磷代谢异常有关。研究表明,SVD的危险因素包括患者因素(如年龄、潜在心血管疾病及合并症)、瓣膜因素(如材料特性、加工工艺和瓣膜类型)以及手术因素(如瓣膜损伤、支架扩张欠佳和支架释放形态不规则)。SVD的临床影像评估在超声心动图、多排螺旋CT和心脏磁共振成像之间具有互补优势,诊断目标各异。经导管主动脉瓣置换术(TAVR)后SVD的主要治疗策略包括药物治疗、再次TAVR、外科主动脉瓣置换术(SAVR)及新型SURPLUS技术。其中,再次TAVR因其微创性已成为常用方法,但仍需进一步明确患者适应证并优化手术策略。SAVR适用于年轻、低风险患者;SURPLUS结合了SAVR和TAVR的优势,适用于再次TAVR不可行或禁忌而SAVR风险过高的病例。本文综述了TAVR治疗后SVD的最新进展,为生物瓣膜耐久性研究及SVD的临床干预提供参考。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8a85/12062941/66a27841c853/1008-9292-2025-54-2-183-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8a85/12062941/66a27841c853/1008-9292-2025-54-2-183-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8a85/12062941/66a27841c853/1008-9292-2025-54-2-183-g001.jpg

相似文献

[1]
[Structural valve deterioration after transcatheter aortic valve replacement: a research update].

Zhejiang Da Xue Xue Bao Yi Xue Ban. 2025-3-25

[2]
Clinical Characteristics and Outcomes of Patients Undergoing 3 Aortic Valve Interventions: The THIRD Multicenter Registry.

JACC Cardiovasc Interv. 2025-1-13

[3]
Aortic Regurgitation, Time to Aortic Valve Reintervention, and Mortality in Degenerated Trifecta Versus Non-Trifecta Bioprosthesis.

Am J Cardiol. 2024-6-1

[4]
Durability of Transcatheter and Surgical Bioprosthetic Aortic Valves in Patients at Lower Surgical Risk.

J Am Coll Cardiol. 2019-2-12

[5]
Structural Deterioration of Transcatheter Versus Surgical Aortic Valve Bioprostheses in the PARTNER-2 Trial.

J Am Coll Cardiol. 2020-10-20

[6]
A systematic review on durability and structural valve deterioration in TAVR and surgical AVR.

Acta Cardiol. 2021-11

[7]
Echocardiographic Results of Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients: The PARTNER 3 Trial.

Circulation. 2020-5-12

[8]
Transcatheter or surgical aortic valve implantation: 10-year outcomes of the NOTION trial.

Eur Heart J. 2024-4-1

[9]
Longitudinal Hemodynamics of Transcatheter and Surgical Aortic Valves in the PARTNER Trial.

JAMA Cardiol. 2017-11-1

[10]
Transcatheter or Surgical Replacement for Failed Bioprosthetic Aortic Valves.

JAMA Cardiol. 2024-7-1

本文引用的文献

[1]
Immune response following transcatheter aortic valve procedure.

Vascul Pharmacol. 2024-3

[2]
Transcatheter or surgical aortic valve implantation: 10-year outcomes of the NOTION trial.

Eur Heart J. 2024-4-1

[3]
Early Biological Valve Failure: Structural Valve Degeneration, Thrombosis, or Endocarditis?

J Clin Med. 2023-9-3

[4]
Outcomes of repeat transcatheter aortic valve replacement with balloon-expandable valves: a registry study.

Lancet. 2023-10-28

[5]
Redo Surgical Aortic Valve Replacement After Prior Transcatheter Versus Surgical Aortic Valve Replacement.

JACC Cardiovasc Interv. 2023-4-24

[6]
Explant vs Redo-TAVR After Transcatheter Valve Failure: Mid-Term Outcomes From the EXPLANTORREDO-TAVR International Registry.

JACC Cardiovasc Interv. 2023-4-24

[7]
Structural Valve Deterioration After Self-Expanding Transcatheter or Surgical Aortic Valve Implantation in Patients at Intermediate or High Risk.

JAMA Cardiol. 2023-2-1

[8]
Dual-crosslinked bioprosthetic heart valves prepared by glutaraldehyde crosslinked pericardium and poly-2-hydroxyethyl methacrylate exhibited improved antithrombogenicity and anticalcification properties.

Acta Biomater. 2022-12

[9]
Cardiac gated multidetector computed tomography (MDCT) to determine valvular leaflet thrombosis and leaflet restriction.

J Card Surg. 2022-12

[10]
Self-expanding Transcatheter vs Surgical Aortic Valve Replacement in Intermediate-Risk Patients: 5-Year Outcomes of the SURTAVI Randomized Clinical Trial.

JAMA Cardiol. 2022-10-1

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