Brouillard Philippe, Diallo El Hadji, Ben Ali Walid, Kouz Rémi
Département de Médecine, Université de Montréal, Montréal, QC H3C 3J7, Canada.
Institut de Cardiologie de Montréal, Montréal, QC H1T 1C8, Canada.
J Clin Med. 2025 Jun 25;14(13):4504. doi: 10.3390/jcm14134504.
Transcatheter aortic valve replacement (TAVR) was first introduced as a minimally invasive treatment for patients with severe aortic stenosis (AS) who are at high or intermediate surgical risk. Recently, its application has expanded to include younger and lower-risk patients, establishing TAVR as a less invasive alternative to surgical aortic valve replacement (SAVR) across the entire surgical spectrum. The expanding utilization of TAVR has driven significant advancements that have greatly enhanced its safety and effectiveness, resulting in a substantial reduction in complications such as paravalvular leak, conduction abnormalities, and periprocedural strokes. Numerous trials have demonstrated the potential superiority of TAVR over conventional surgery in achieving favorable clinical outcomes. Furthermore, the increasing number of long-term trials has provided valuable insight into TAVR outcomes in previously under-studied populations, including patients with complex anatomies. However, significant challenges remain, particularly in ensuring the long-term durability of transcatheter valves, with younger patients likely to outlive their bioprosthetic valves. Consequently, the focus is shifting towards lifetime management strategies, including considerations for coronary re-access, the risk of coronary obstruction, and prosthesis-patient mismatch. This review explores key developments in the field, including TAVR for aortic regurgitation and bicuspid anatomy, the emerging role of TAVR in moderate and asymptomatic AS, and innovations in valve design and procedural planning. We also examine novel imaging tools, adjunctive technologies, and strategies to address coronary access and re-intervention. As long-term data accumulate, these evolving trends will shape the future of TAVR and its role in managing aortic valve disease across increasingly complex clinical scenarios.
经导管主动脉瓣置换术（TAVR）最初作为一种微创治疗方法，用于手术风险高或中等的严重主动脉瓣狭窄（AS）患者。最近，其应用范围已扩大到包括更年轻、风险更低的患者，使TAVR成为整个手术范围内外科主动脉瓣置换术（SAVR）的一种侵入性较小的替代方法。TAVR使用的不断扩大推动了重大进展，极大地提高了其安全性和有效性，导致瓣周漏、传导异常和围手术期卒中等并发症大幅减少。大量试验表明，TAVR在实现良好临床结果方面优于传统手术。此外，越来越多的长期试验为之前研究不足的人群（包括解剖结构复杂的患者）的TAVR结果提供了有价值的见解。然而，重大挑战仍然存在，特别是在确保经导管瓣膜的长期耐用性方面，年轻患者可能比他们的生物瓣膜活得更长。因此，重点正在转向终身管理策略，包括考虑冠状动脉再次接入、冠状动脉阻塞风险和人工瓣膜-患者不匹配问题。本综述探讨了该领域的关键进展，包括用于主动脉瓣反流和二叶式解剖结构的TAVR、TAVR在中度和无症状AS中的新作用以及瓣膜设计和手术规划方面的创新。我们还研究了新型成像工具、辅助技术以及解决冠状动脉接入和再次干预的策略。随着长期数据的积累，这些不断演变的趋势将塑造TAVR的未来及其在越来越复杂的临床场景中管理主动脉瓣疾病的作用。
