2012ESC心脏瓣膜病治疗指南解读及启示

Inerpretation and enlightenment of 2012 ESC guideline on the mangement of vavular heart disease

2012年新版心脏瓣膜疾病(VHD)防治指南在德国慕尼黑ESC大会上由欧洲心脏病协会(ESC)和欧洲心胸外科协会(EACTS)联合发布。指南更新是基于过去5年里新收集到的临床证据,主要变化包括:淡化对EuroSCORE及STS评分的依赖,强调构建心脏团队对患者管理的重要性,明确了经导管主动脉瓣植入术(TAVI)以及经皮缘对缘瓣膜修复术的指针,以及术后抗凝策略的调整等。指南还进一步提示我们:虽然心脏瓣膜病的介入治疗取得了长足的进展,从而使得外科手术不再是某些瓣膜病的惟一治疗方法,但介入治疗仍有许多问题,如适应证的选择、多中心大样本的追踪随访及远期疗效评价、并发症等。在相关条件尚不成熟的大中型医院建议不开展此类诊疗技术。对待新的诊疗技术,我们应该遵循积极探索、谨慎推进的原则,切记冒进。

The 2012 edition of valvular heart disease （VHD） prevention and treatment guideline jointly was issued by the European Society of Cardiology （ESC） and the European Association of Cardiothoracic Surgery （EACTS） in Munich, Ger- many on the ESC Congress. The guideline update was based on the new clinical evidence collected in the past five years. Major changes include：desalinated the dependence of EuroSCORE and STS score, stressed the importance of establishing the team of heart management for patients, made clear the indications of transcatheter aortic valve implantation （TAVI） and percutaneous edge-to-edge valve repair, and adjusted the strategy of postoperative anticoagulation. The guideline also sugges- ted us that although interventional treatment of VHD had made considerable progress, sometimes making surgery no longer the only treatment of certain valvular disease, it still had many problems such as choice of indications, management of com- plications, and follow-up and long-term efficacy evaluation of large-sample, multicenter research. It is not recommended to use this treatment in the big- or medium-sized hospitals whose relevant conditions were not yet mature. For the new clinic technology, we should follow the principles of actively exploring and cautiously advancing.