PERIGON研究5年随访结果解读及外科主动脉瓣生物瓣置换的思考

Implications of five-year outcomes of PERIGON trial for bioprosthetic aortic valve replacement

对于需瓣膜置换的主动脉瓣病变,外科主动脉瓣置换术(surgical aortic valve replacement,SAVR)一直是标准治疗。由于机械瓣术后需长期抗凝及相关的出血血栓风险,近年来生物瓣适应人群趋于年轻化,随之而来的是对其耐久性的关注。最新公布的PERIGON研究5年随访结果,以零结构性瓣膜衰败再次显示了新一代外科生物瓣良好的耐久性,为其在相对年轻患者中的应用进一步提供了依据。同时,经导管主动脉瓣植入术(transcatheter aortic valve implantation,TAVI)的快速发展也带来新的治疗选择。对于相对年轻、低危患者,选择SAVR或TAVI,成为重要的决策问题。本文就PERIGON研究结果以及给主动脉瓣置换临床实践和研究带来的思考进行述评。

For patients with aortic valve disease who require replacement of their native valve,surgical aortic valve replacement(SAVR)has been the standard of care.Due to the hemorrhage and thromboembolic risks of long-term anticoagulation therapy for mechanical prosthesis,bioprosthetic aortic valve replacement(AVR)has a trend to be used in younger patients,which raising the concern for the durability of bioprosthetic valves.The newly published 5-year outcomes of PERIGON trial,with no structural valve deterioration,again demonstrated the favorable durability of the new generation bioprosthetic valves,further providing the evidence of using bioprosthetic AVR in younger patients.At the meantime,the rapid progress of transcatheter aortic valve implantation(TAVI)has brought a new treatment option.For younger patients with low risks,choosing SAVR or TAVI becomes a critical decision.This paper reviews the outcomes of PERIGON trial and its implications to the clinical practice and research of bioprosthetic AVR.