经导管主动脉瓣置换术研究现状及进展

Research status and progress on transcatheter aortic valve replacement

经导管主动脉瓣置换(transcatheter aortic valve replacement,TAVR)是一项治疗严重主动脉瓣狭窄的新型微创技术,目前主要应用于存在高危、中危风险或手术禁忌证的患者。本文总结了目前TAVR的植入路径、围术期影像学检查、TAVR系统的研发和应用进展。植入路径主要包括经股动脉、经心尖路径、经主动脉等。超声和多层螺旋CT是围术期的主要影像学依据。34 mm Evolut R瓣膜和Sapien 3瓣膜的新型设计,明显减少了瓣周漏的发生,并为髂血管异常的患者实施TAVR提供了可能。JenaValve获准应用于治疗主动脉瓣关闭不全,拓宽了TAVR的适应证。最后对TAVR的发展进行了展望。

Transcatheter aortic valve replacement （ TAVR） has emerged as the preferred treatment strategy for patients with severe, symptomatic aortic stenosis considered at prohibitive, high, intermediate risk for surgical aortic valve replacement. This manuscript has summarized various accesses of TAVR, imaging features and novel designs of TAVR. There are multiple avenues for delivery of TAVR devices, including the transfemoral route, transapical access, transaortic and other techniques. Transesophageal echocardiography and multidetector computed tomography are the major imaging means for TAVR. Innovative design in Evolut R 34mm valve and Sapien 3 may reduce the amount of residual paravalvular regurgitation and offer increased success through transfemoral access. JenaValve technology has received extended Conformite Europeenne mark approval for the treatment of aortic regurgitation, which broadens the indication of TAVR. Finally we provide an outlook of the future of TAVR.