Yan Mengyun, Zhao Zhengang, Chen Mao
Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, China.
Zhejiang Da Xue Xue Bao Yi Xue Ban. 2025 Mar 25;54(2):183-190. doi: 10.3724/zdxbyxb-2024-0470.
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.
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。
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