经导管主动脉瓣置换术治疗老年重度主动脉瓣狭窄研究进展

Research progress on transcatheter aortic valve replacement in the treatment of severe aortic stenosis in the elderly

随着经济社会健康发展,人均寿命的延长,老年性瓣膜病的发病率也呈升高趋势,尤其是主动脉瓣狭窄(AS)。对于老年重度AS患者,若不尽快临床干预,其预后不良,病死率将明显增高。外科手术行瓣膜置换术(SAVR)是过去首选治疗方法,但因其创伤很大,恢复缓慢,并且临床上还有众多高龄、左心室功能衰竭、体质虚弱以及合并多脏器严重功能低下的患者,其身体状况较差,不能耐受外科手术治疗。近年来,经导管主动脉瓣置换术(TAVR)已逐渐成为高危重度或者外科手术禁忌的AS患者的一种替代治疗选择,其创伤极小、恢复速度快。经过近些年的实践和发展,各医疗中心的经验不断增加,且大量的临床实验研究也证实了其有效性和安全性。目前为止,全球已有超过50万例患者接受了TAVR,虽然有一定风险和围手术期并发症,如冠状动脉阻塞、瓣周旁漏、卒中、需要永久起搏器的传导阻滞,急性肾损伤等,但总体上均获得了不亚于外科置换手术的理想效果。随着临床介入技术的进步、临床治疗实践经验的积累,瓣膜功能、稳定性及持久性将进一步加强完善,必将推动TAVR广泛临床应用,并有望进一步拓宽其适应症,使之成为治疗老年主动脉瓣狭窄安全有效的方法。本文将详细介绍TAVR技术的科学研究进展以及未来发展方向。

With the healthy development of economy and society and the prolongation of life expectancy,the incidence of senile valvular disease is also increasing,especially aortic stenosis(AS).For elderly patients with severe AS,if the clinical intervention is not carried out as soon as possible,the prognosis will be poor,and the fatality rate will be significantly increased.Surgical valve replacement(SAVR)was the preferred treatment in the past,but because of its great trauma,slow recovery,and clinically many patients with advanced age,leftventricular failure,physical weakness,and multiple organ dysfunction,whose physical condition are poor and cannot tolerate surgical treatment.In recent years,transcatheter aortic valve replacement(TAVR)has gradually become an alternative treatment option for high-risk severe or surgically contraindicated AS patients,with minimal trauma and rapid recovery.After the practice and development in recent years,the experience of each medical center has been continuously increased,and a large number of clinical experimental studies have also confirmed its effectiveness and safety.To date,more than 500,000 patients have received TAVR worldwide,although there are certain risks and perioperative complications such as coronary artery occlusion,paravalvular leak,stroke,conduction block requiring permanent pacemaker,acute renal failure Injuries,etc.,but generally achieved ideal results no less than surgical replacement surgery.With the advancement of clinical interventional technology and the accumulation of practical experience in clinical treatment,valve function,stability and durability will be further enhanced and improved,which will surely promote the wide clinical application of TAVR,and is expected to further broaden its indications and make it a safe and effective method for arterial valve stenosis treatment for the elderly.This article will introduce the scientific research progress and future development direction of TAVR technology in detail.