The Promise and Perils of Transcatheter Aortic Valve Replacement (TAVR) in Low Surgical Risk Patients with Severe Aortic Stenosis in the Current Era.

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Cardiology Reports Pub Date : 2024-11-01 Epub Date: 2024-08-16 DOI:10.1007/s11886-024-02116-4

Ahmed Hassanin, Molly Szerlip

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Abstract

Purpose of review: Transcatheter Aortic Valve Replacement (TAVR) has become the preferred treatment approach for many patients with symptomatic severe aortic valve stenosis (SsAS), particularly those who are deemed at high surgical risk. However, in low-risk surgical patients (LSRP) with SsAS, the choice between TAVR and surgical aortic valve replacement (SAVR) is often a matter of debate and depends on several clinical and anatomical considerations.

Recent findings: Midterm data show similar clinical outcomes and durability of TAVR and SAVR bioprosthetic valves in LRSP. Data on long term durability and outcomes of TAVR in LRSP remains scarce. Both TAVR and SAVR are reasonable options in LRSP with SsAS. Nevertheless, many of these LRSP are expected to outlive their bioprosthetic valves and planning for the second aortic valve replacement should begin at the time of the index procedure with special consideration for coronary re-access, risk for coronary obstruction, and prothesis patient mismatch.

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经导管主动脉瓣置换术 (TAVR) 在当前时代对手术风险低的重度主动脉瓣狭窄患者的承诺与危险。

审查目的：经导管主动脉瓣置换术（TAVR）已成为许多无症状重度主动脉瓣狭窄（SsAS）患者的首选治疗方法，尤其是那些被认为具有高手术风险的患者。然而，对于手术风险较低的 SsAS 患者（LSRP），在 TAVR 和外科主动脉瓣置换术（SAVR）之间做出选择往往是一个争论不休的问题，这取决于多个临床和解剖学方面的考虑因素：中期数据显示，TAVR 和 SAVR 生物人工瓣膜在 LRSP 中的临床疗效和耐用性相似。有关 TAVR 在 LRSP 中的长期耐久性和疗效的数据仍然很少。对于患有 SsAS 的 LRSP，TAVR 和 SAVR 都是合理的选择。尽管如此，许多 LRSP 患者的生物瓣膜寿命预计将超过其人工瓣膜的寿命，因此在进行指数手术时就应开始规划第二次主动脉瓣置换术，并特别考虑冠状动脉再通路、冠状动脉阻塞风险和人工瓣膜患者不匹配等问题。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current Cardiology Reports CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

6.20

自引率

2.70%

发文量

209

期刊介绍： The aim of this journal is to provide timely perspectives from experts on current advances in cardiovascular medicine. We also seek to provide reviews that highlight the most important recently published papers selected from the wealth of available cardiovascular literature. We accomplish this aim by appointing key authorities in major subject areas across the discipline. Section editors select topics to be reviewed by leading experts who emphasize recent developments and highlight important papers published over the past year. An Editorial Board of internationally diverse members suggests topics of special interest to their country/region and ensures that topics are current and include emerging research. We also provide commentaries from well-known figures in the field.