经导管主动脉瓣置换治疗单纯主动脉瓣反流的研究进展

Advances in transcatheter aortic valve replacement for pure aortic regurgitation

经导管主动脉瓣置换术(transcatheter aortic valve replacement,TAVR)治疗主动脉瓣狭窄已被证明有较好的安全性和有效性,其地位随着指南的不断更新逐渐提高,但对于单纯主动脉瓣重度反流,长期以来被视为TAVR治疗的相对禁忌证。然而许多高龄、高危单纯主动脉瓣反流患者由于外科手术禁忌或不耐受,也通过标签外使用经导管人工瓣膜,得到了TAVR治疗并改善了预后,但由于解剖特点的复杂性和挑战性、手术技术要求高、器械成功率有限、手术并发症多等因素,且缺乏随机对照研究证实其安全和有效性,单纯主动脉瓣反流的TAVR治疗一直在争论中发展。近年来,随着新一代瓣膜的应用和研究数量的增多,对于TAVR治疗主动脉瓣重度反流又有了一些新的认识,本文将对TAVR治疗单纯主动脉瓣重度反流的研究进展作一综述。

Transcatheter aortic valve replacement(TAVR)for aortic stenosis has been confirmed to be safe and efficient,and its status has gradually increased with the continuous updating of guidelines.But for severe pure aortic valve regurgitation,it has long been considered a relative contraindication to TAVR.However,many elderly,high-risk patients with pure aortic regurgitation have also been treated with TAVR and prognosis was improved through off-label use of transcatheter heart valves due to contraindications to surgery or intolerance.But because of the complexity and challenging anatomic features,high technical requirements,limited device success rate,high rate of complications,and lack of randomized controlled studies to confirm its safety and efficacy,TAVR treatment of pure aortic regurgitation has been evolving in a debate.In recent years,with the application of new-generation valves and an increasing number of studies,some new insights have been gained regarding TAVR for severe aortic regurgitation,and this article will review the progress of research on TAVR for severe pure aortic regurgitation.