作者：朱锋，郭文秀，王海龙，牟洋筠

单位：

1.404000重庆市，重庆大学附属三峡医院心血管内科 2.637000四川省南充市，川北医学院 通信作者：牟洋筠，E-mail：157545785@qq.com

Units：

1.Department of Cardiology, Chongqing University Three Gorges Hospital, Chongqing 404000, China 2.North Sichuan Medical College, Nanchong 637000, China Corresponding author: MOU Yangjun, E-mail: 157545785@qq.com

关键词：

经导管主动脉瓣置换术; 外科主动脉瓣置换术; 心脏瓣膜; 耐用性;

Keywords：

Transcatheter aortic valve replacement; Surgical aortic valve replacement; Heart valves; Durability

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.154

Funds：

摘要：

《2017 AHA/ACC指南:心脏瓣膜病患者的管理(更新版)》将外科主动脉瓣置换术(SAVR)禁忌/高危及中危患者采用经导管主动脉瓣置换术(TAVR)治疗分别作为Ⅰ类和Ⅱa类推荐。近年来随着瓣膜研究增多,不同瓣膜的优势和劣势得到了广泛关注;随着TAVR适应证的扩大(包括低龄和SAVR低危患者)及行TAVR患者预期寿命延长,其瓣膜耐用性问题逐渐凸显。笔者通过分析文献发现,TAVR已成为治疗SAVR禁忌的重度主动脉瓣狭窄患者的首选方案,此外其在SAVR高危、中危、低危患者中亦具有良好的应用前景;球囊扩张式瓣膜较自膨胀式瓣膜在降低患者死亡风险与并发症发生风险方面似乎更有优势,机械扩张式瓣膜不劣于自膨胀式瓣膜;新一代自膨胀式瓣膜改善了大瓣环的密封性,对小瓣环具有潜在优势;行TAVR的患者5～10年SVD发生率为3.2%～14.9%,BVF发生率为0.6%～7.5%,TAVR瓣膜具有良好的耐用性。

Abstract：

【Abstract】　In 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients withvalvular heart disease, transcatheter aortic valve replacement (TAVR) treatment for surgical aortic valve replacement (SAVR)taboo/high-risk and medium-risk patients was recommended as categoryⅠandⅡa, respectively. In recent years, with the increaseof valve about research, the advantages and disadvantages of different valves have attracted extensive attention; with the expansionof TAVR indications (including low-age patients and SAVR low-risk patients) and the prolongation of life expectancy of patientsundergoing TAVR, the problem of valve durability is prominent. By analyzing the literature, the author found that TAVR hasbecome the first choice for the treatment of patients with severe aortic stenosis contraindicated by SAVR. In addition, TAVR hasa good application prospect in high-risk, medium-risk and low-risk patients with SAVR; balloon-expandable valve seems tohave more advantages than self-expanding valves in reducing the risk of death and complications, and mechanical-expandablevalve is not inferior to self-expanding valve; the new generation of self-expanding valve improves the sealing of large ring and haspotential advantages for small ring. The incidence of SVD and BVF in patients undergoing TAVR in 5-10 years were 3.2%-14.9%and 0.6%-7.5%, respectively. TAVR valve has good durability.

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