经导管主动脉瓣置换术治疗主动脉瓣狭窄应用进展

Application progress of transcatheter aortic valve replacement for aortic stenosis

主动脉瓣狭窄(AS)是在解剖层面导致心脏射血受阻、心脏负荷增加以及冠状动脉、脑血管和全身脏器供血受限的疾病,对患者产生重要影响。随着我国老龄化进程加快,老年主动脉瓣钙化、退变导致AS患者越来越多,针对这类患者采取合适的治疗方案非常重要。AS根本治疗是瓣膜置换。外科主动脉瓣置换术(SAVR)对年轻AS患者耐受性良好,但仍存在创伤大等缺陷,对老年患者风险很高,并发症发生率也很高。微创经导管主动脉瓣置换术(TAVR)是老年AS患者的重要选择。该文就AS,TAVR手术患者、手术入路、人工瓣膜类型选择,术后抗栓策略,术后并发症及其处理及术后康复治疗等应用进展作一综述。

Aortic stenosis(AS) is a disease that, at the anatomical level, leads to obstruction of cardiac ejection, increase of cardiac load and restriction of blood supply to coronary artery, cerebrovascular and systemic organs, which produce important impact on the health of the patients. With the speeding up of the aging process in China, more and more AS patients have been detected in the elderly population, so it is very important to adopt appropriate treatment schemes for these patients. The fundamental treatment of AS is valve replacement. Surgical aortic valve replacement(SAVR) can be well tolerated by young patients, although it has disadvantages such as larger injury, etc. Therefore, for elderly patients SAVR carries high risks and high incidence of complications. Minimally-invasive transcatheter aortic valve replacement(TAVR) is an ideal alternative for elderly patients with AS. This paper aims to make a comprehensive review about the TAVR therapy of AS,focusing on the latest progress in TAVR applications, including operative procedure, operative approach,selection of the artificial valve type, postoperative anti-thrombosis strategy, postoperative complications and therapeutic measures, postoperative rehabilitation treatment, etc.(J Intervent Radiol, 2022, 31: 1020-1026)