心脏瓣膜病治疗:经导管瓣膜治疗的适应人群——2020年ACC/AHA瓣膜病管理指南解读和思考

Management of valvular heart disease:the suitable population for transcatheter intervention—insight from the 2020 ACC/AHA guideline for the management of patients with valvular heart disease

经导管瓣膜治疗以其“微创”优势,早期应用于外科手术禁忌或高风险患者。在随后与传统外科手术或当前最佳药物治疗对比的随机对照试验中,经导管瓣膜治疗的安全性和有效性逐步得到证实。近20年来,随着经导管瓣膜治疗的器械大量涌现,技术不断发展,经导管瓣膜治疗也逐渐开始挑战外科手术中低风险人群和解剖条件更为复杂瓣膜,并取得了不俗成绩。为此,该文结合国内外最新研究进展和2020年美国心脏病学会(ACC)/美国心脏协会(AHA)瓣膜病管理指南,主要就经导管瓣膜治疗适应人群进行探讨。

Transcatheter intervention for valvular heart disease,featuring in less invasiveness,was initially introduced for patients with surgical contraindications or at high surgical risk.High-quality randomized controlled trials have established its safety and effectiveness for the management of valvular heart disease compared to conventional surgeries or state-of-art medications.Over the past two decades,we have seen a large number of novel instruments and technological improvements on transcatheter valve therapy.Thus,the indications for transcatheter valve therapy have expanded,currently aiming at patients with low surgical risk or challenging anatomies,and the transcatheter valve therapy has achieved good preliminary results.In this paper,we investigate who are suitable for transcatheter intervention for valvular heart disease,based on the 2020 American College of Cardiogy(ACC)/American Heart Association(AHA)guideline for the management of patients with valvular heart disease and the latest literatures reviewing.