Transcatheter aortic valve replacement: clinical researches and progress of application

Jun JIN

doi:10.16016/j.1000-5404.201906158

您当前的位置：

首页 >

文章列表页 >

Transcatheter aortic valve replacement: clinical researches and progress of application

Expert Reviews | 更新时间：2026-01-09

- Transcatheter aortic valve replacement: clinical researches and progress of application
- Journal of Third Military Medical University Vol. 41, Issue 19, Pages: 1873-1880(2019)
- 作者机构：
  
  400037 重庆，陆军军医大学(第三军医大学)第二附属医院心血管内科，全军心血管病研究所
- 作者简介：
- 基金信息：
- DOI：10.16016/j.1000-5404.201906158
  CLC： R540.46;R542.52
- Received：21 June 2019，
  
  Revised：2019-08-31，
  
  Published：15 October 2019
- 稿件说明：
移动端阅览
Jun JIN. Transcatheter aortic valve replacement: clinical researches and progress of application[J]. Journal of Third Military Medical University, 2019, 41(19): 1873-1880.
DOI：

Jun JIN. Transcatheter aortic valve replacement: clinical researches and progress of application[J]. Journal of Third Military Medical University, 2019, 41(19): 1873-1880. DOI： 10.16016/j.1000-5404.201906158.

摘要

经导管主动脉瓣置换术(transcatheter aortic valve replacement，TAVR)是过去10余年介入心脏病学发展最深广的一项技术，目前已经成为重度主动脉瓣狭窄(aortic stenosis，AS)且外科主动脉瓣置换术(surgical aortic valve replacement，SAVR)有禁忌，以及高危患者的首选治疗方法。随着器械改进、技术进步、经验累积，近几年TAVR得到了更加广泛的应用。临床研究显示对外科手术中危的重度AS患者，TAVR组患者主要复合终点事件的发生率并不高于SAVR，甚至在接受经股动脉入路的TAVR患者中，其终点事件的发生率显著低于SAVR组。同时，在低危手术风险的患者中，研究也证实TAVR显示出不劣于SAVR的治疗效果。随着TAVR的不断发展，其在二叶式主动脉瓣狭窄、衰败生物瓣膜，以及单纯主动脉瓣反流患者中的应用得到了密切关注，并且其有效性和安全性也得到了初步的证实。但是，目前TAVR带来的主要手术并发症会影响患者的预后，如何减少诸如冠状动脉阻塞、卒中、瓣周漏、传导阻滞以及血管损伤等并发症的发生是未来研究的主要方向，以使TAVR能够更好地造福主动脉瓣疾病患者。

Abstract

In the past decade

interventional cardiology has been revolutionized by transcatheter aortic valve replacement (TAVR)

which has been developing greatly and become the preferred treatment for severe symptomatic aortic stenosis (AS) patients with high surgical risk

and for those contraindicated to surgical aortic valve replacement (SAVR). With improvements in devices and technology and increasing experience of operators

TAVR has gained wide acceptance and been applied extensively. It has been demonstrated that the primary composite end point in TAVR group was not inferior to SAVR in AS patients with intermediate operative risk

and the outcomes were even better than SAVR in the transfemoral TAVR subgroup. Meanwhile

in recent

evidence shows the non-inferiority of TAVR to SAVR in low-risk severe AS patients. With the development of TAVR

more attentions have been paid to the application of TAVR in patients with bicuspid aortic valve stenosis

degenerated aortic surgical bioprosthese and pure severe aortic regurgitation

in which the efficacy and safety of TAVR are promising. However

the major complications of TAVR have proved to be prognostic factors. How to reduce the incidence of major complications

such as coronary obstruction

stoke

paravalvular leak

conduction disorders and vascular complications

is hot research topic of future studies

which will benefit more patients with aortic valve diseases.

关键词

Keywords

references

KELLY T A, ROTHBART R M, COOPER C M, et al . Comparison of outcome of asymptomatic to symptomatic patients older than 20 years of age with valvular aortic stenosis[J ] . Am J Cardiol, 1988, 61(1): 123-130. DOI:10.1016/0002-9149(88)91317-3.

TURINA J, HESS O, SEPULCRI F, et al . Spontaneous course of aortic valve disease[J ] . Eur Heart J, 1987, 8(5): 471-483. DOI:10.1093/oxfordjournals.eurheartj.a062307.

CRIBIER A, ELTCHANINOFF H, BASH A, et al . Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description[J ] . Circulation, 2002, 106(24): 3006-3008. DOI:10.1161/01.cir.0000047200.36165.b8.

吴永健.经导管主动脉瓣置换术的现状、研究热点和未来展望[J].中国循环杂志2017, 32(2):120-122. DOI:10.3969/j.issn.1000-3614.2017.02.002。

WU Y J. Current status, focus and future perspectives of transcatheter aortic valve replacement[J]. Chin Circ J, 2017, 32(2): 120-122. DOI:10.3969/j.issn.1000-3614.2017.02.002.

高润霖.中国心瓣膜病现状[J].华西医学, 2018, 33(2):127-131. DOI:10.7507/1002-0179.201712108.

GAO R L. Current status of valvular heart disease in China[J]. West China Med J, 2018, 33(2): 127-131. DOI:10.7507/1002-0179.201712108.

MAKKAR R R, FONTANA G P, JILAIHAWI H, et al . Transcatheter aortic-valve replacement for inoperable severe aortic stenosis[J ] . N Engl J Med, 2012, 366(18): 1696-1704. DOI:10.1056/NEJMoa1202277.

KAPADIA S R, LEON M B, MAKKAR R R, et al . 5-year outcomes of transcatheter aortic valve replacement compared with standard treatment for patients with inoperable aortic stenosis (PARTNER 1): a randomised controlled trial[J ] . Lancet, 2015, 385(9986): 2485-2491. DOI:10.1016/S0140-6736(15)60290-2.

POPMA J J, ADAMS D H, REARDON M J, et al . Trans-catheter aortic valve replacement using a self-expanding bioprosthesis in patients with severe aorticstenosis at extreme risk for surgery[J ] . J Am Coll Cardiol, 2014, 63(19): 1 972-1981. DOI:10.1016/j.jacc.2014.02.556.

NISHIMURA R A, OTTO C M, BONOW R O, et al . 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association task force on practice guidelines[J ] . Circulation, 2014, 129(23): e521-e643. DOI:10.1161/CIR.0000000000000031.

NISHIMURA R A, OTTO C M, BONOW R O, et al . 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines[J ] . J Am Coll Cardiol, 2017, 70(2): 252-289. DOI:10.1016/j.jacc.2017.03.011.

SMITH C R, LEON M B, MACK M J, et al . Transcatheter versus surgical aortic-valve replacement in high-risk patients[J ] . N Engl J Med, 2011, 364(23): 2187-2198. DOI:10.1056/NEJMoa1103510.

MACK M J, LEON M B, SMITH C R, et al . 5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): a randomised controlled trial[J ] . Lancet, 2015, 385(9986): 2477-2484. DOI:10.1016/S0140-6736(15)60308-7.

ADAMS D H, POPMA J J, REARDON M J. Transcatheter aortic-valve replacement with a self-expanding prosthesis[J]. N Engl J Med, 2014, 371(10): 967-968. DOI:10.1056/NEJMc1408396.

REARDON M J, ADAMS D H, KLEIMAN N S, et al . 2-year outcomes in patients undergoing surgical or self-expanding transcatheter aortic valve replacement[J ] . J Am Coll Cardiol, 2015, 66(2): 113-121. DOI:10.1016/j.jacc.2015.05.017.

REARDON M J, VAN MIEGHEM N M, POPMA J J, et al . Surgical or transcatheter aortic-valve replacement in intermediate-risk patients[J ] . N Engl J Med, 2017, 376(14): 1321-1331. DOI:10.1056/NEJMoa1700456.

LEON M B, SMITH C R, MACK M J, et al . Transcatheter or surgical aortic-valve replacement in intermediate-risk patients[J ] . N Engl J Med, 2016, 374(17): 1609-1620. DOI:10.1056/NEJMoa1514616.

BAUMGARTNER H, FALK V, BAX J J, et al . 2017 ESC/EACTS Guidelines for the management of valvular heart disease[J ] . Kardiologia Polska, 2018: 1-62. DOI:10.5603/kp.2018.0013.

THYREGOD H G, STEINBRVCHEL D A, IHLEMANN N, et al . Transcatheter versus surgical aortic valve replacement in patients with severe aortic valve stenosis: 1-year results from the all-comers NOTION randomized clinical trial[J ] . J Am Coll Cardiol, 2015, 65(20): 2184-2194. DOI:10.1016/j.jacc.2015.03.014.

THYREGOD H G H, IHLEMANN N, JØRGENSEN T H, et al . Five-year clinical and echocardiographic outcomes from the Nordic aortic valve intervention (NOTION) randomized clinical trial in lower surgical risk patients[J ] . Circulation, 2019, 139(24): 2714-2723. DOI:10.1161/circulationaha.118.036606.

MACK M J, LEON M B, THOURANI V H, et al . Trans-catheter aortic-valve replacement with a balloon-expandable valve in low-risk patients[J ] . N Engl J Med, 2019, 380(18): 1695-1705. DOI:10.1056/NEJMoa1814052.

POPMA J J, DEEB G M, YAKUBOV S J, et al . Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients[J ] . N Engl J Med, 2019, 380(18): 1706-1715. DOI:10.1056/NEJMoa1816885.

ZHAO Z G, JILAIHAWI H, FENG Y, et al . Transcatheter aortic valve implantation in bicuspid anatomy[J ] . Nat Rev Cardiol, 2015, 12(2): 123-128. DOI:10.1038/nrcardio.2014.161.

SANNINO A, CEDARS A, STOLER R C, et al . Comparison of efficacy and safety of transcatheter aortic valve implantation in patients with bicuspid versus tricuspid aortic valves[J ] . Am J Cardiol, 2017, 120(9): 1601-1606. DOI:10.1016/j.amjcard.2017.07.053.

KOCHMAN J, HUCZEK Z, SCISŁO P, et al . Comparison of one- and 12-month outcomes of transcatheter aortic valve replacement in patients with severely stenotic bicuspid versus tricuspid aortic valves (results from a multicenter registry)[J ] . Am J Cardiol, 2014, 114(5): 757-762. DOI:10.1016/j.amjcard.2014.05.063.

YOON S H, BLEIZIFFER S, DE BACKER O, et al . Outcomes in transcatheter aortic valve replacement for bicuspid versus tricuspid aortic valve stenosis[J ] . J Am Coll Cardiol, 2017, 69(21): 2579-2589. DOI:10.1016/j.jacc.2017.03.017.

LIAO Y B, LI Y J, XIONG T Y, et al . Comparison of procedural, clinical and valve performance results of transcatheter aortic valve replacement in patients with bicuspid versus tricuspid aortic stenosis[J ] . Int J Cardiol, 2018, 254: 69-74. DOI:10.1016/j.ijcard.2017.12.013.

WEBB J G, MACK M J, WHITE J M, et al . Transcatheter aortic valve implantation within degenerated aortic surgical bioprostheses: PARTNER 2 valve-in-valve registry[J ] . J Am Coll Cardiol, 2017, 69(18): 2253-2262. DOI:10.1016/j.jacc.2017.02.057.

DVIR D, WEBB J G, BLEIZIFFER S, et al . Transcatheter aortic valve implantation in failed bioprosthetic surgical valves[J ] . JAMA, 2014, 312(2): 162-170. DOI:10.1001/jama.2014.7246.

ROY D A, SCHAEFER U, GUETTA V, et al . Transcatheter aortic valve implantation for pure severe native aortic valve regurgitation[J ] . J Am Coll Cardiol, 2013, 61(15): 1577-1584. DOI:10.1016/j.jacc.2013.01.018.

SAWAYA F J, DEUTSCH M A, SEIFFERT M, et al . Safety and efficacy of transcatheter aortic valve replacement in the treatment of pure aortic regurgitation in native valves and failing surgical bioprostheses: results from an international registry study[J ] . JACC Cardiovasc Interv, 2017, 10(10): 1048-1056. DOI:10.1016/j.jcin.2017.03.004.

RIBEIRO H B, WEBB J G, MAKKAR R R, et al . Predictive factors, management, and clinical outcomes of coronary obstruction following transcatheter aortic valve implantation: insights from a large multicenter registry[J ] . J Am Coll Cardiol, 2013, 62(17): 1552-1562. DOI:10.1016/j.jacc.2013.0 7.040.

JABBOUR R J, TANAKA A, FINKELSTEIN A, et al . Delayed coronary obstruction after transcatheter aortic valve replacement[J ] . J Am Coll Cardiol, 2018, 71(14): 1513-1524. DOI:10.1016/j.jacc.2018.01.066.

BLANKE P, SOON J, DVIR D, et al . Computed tomography assessment for transcatheteraortic valve in valve implantation: The Vancouver approach to predict anatomical risk for coronary obstruction and other considerations[J ] . J Cardiovasc Comput Tomogr, 2016, 10(6): 491-499. DOI:10.1016/j.jcct.2016.09.004.

FETAHOVIC T, HAYMAN S, COX S, et al . The prophylactic chimney snorkel technique for the prevention of acute coronary occlusion in high risk for coronary obstruction transcatheter aortic valve replacement/implantation cases[J ] . Heart Lung Circ, 2019: S1443-S9506(19)30348-8. DOI:10.1016/j.hlc.2019.04.009.

KAPPETEIN A P, HEAD S J, GÉNÉREUX P, et al . Updated standardized endpoint definitions for transcatheter aortic valve implantation: the valve academic research consortium-2 consensus document[J ] . J Am Coll Cardiol, 2012, 60(15): 1438-1454. DOI:10.1016/j.jacc.2012.09.001.

KODALI S, THOURANI V H, WHITE J, et al . Early clinical and echocardiographic outcomes after SAPIEN 3 transcatheter aortic valve replacement in inoperable, high-risk and intermediate-risk patients with aortic stenosis[J ] . Eur Heart J, 2016, 37(28): 2252-2262. DOI:10.1093/eurheartj/ehw112.

SORAJJA P, KODALI S, REARDON M J, et al . Outcomes for the commercial use of self-expanding prostheses in transcatheter aortic valve replacement: A report from the STS/ACC TVT registry[J ] . JACC Cardiovasc Interv, 2017, 10(20): 2090-2098. DOI:10.1016/j.jcin.2017.07.027.

LANSKY A J, SCHOFER J, TCHETCHE D, et al . A prospective randomized evaluation of the TriGuard TM HDH embolic DEFLECTion device during transcatheter aortic valve implantation: results from the DEFLECT Ⅲ trial[J ] . Eur Heart J, 2015, 36(31): 2070-2078. DOI:10.1093/eurheartj/ehv191..

KAPADIA S R, KODALI S, MAKKAR R, et al . Protection against cerebral embolism during transcatheter aortic valve replacement[J ] . J Am Coll Cardiol, 2017, 69(4): 367-377. DOI:10.1016/j.jacc.2016.10.023.

HAUSSIG S, MANGNER N, DWYER M G, et al . Effect of a cerebral protection device on brain lesions following transcatheter aortic valve implantation in patients with severe aortic stenosis: the CLEAN-TAVI randomized clinical trial[J ] . JAMA, 2016, 316(6): 592-601. DOI:10.1001/jama.2016.10302.

TAKAGI H, UMEMOTO T, ALICE (All-Literature Investigation of Cardiovascular Evidence) GROUP. Impact of paravalvular aortic regurgitation after transcatheter aortic valve implantation on survival[J]. Int J Cardiol, 2016, 221: 46-51. DOI:10.1016/j.ijcard.2016.07.006.

BLACKMAN D J, MEREDITH I T, DUMONTEIL N, et al . Predictors of paravalvular regurgitation after implantation of the fully repositionable and retrievable lotus transcatheter aortic valve (from the REPRISE Ⅱ trial extended cohort)[J ] . Am J Cardiol, 2017, 120(2): 292-299. DOI:10.1016/j.amjcard.2017.04.026.

BAX J J, DELGADO V, BAPAT V, et al . Open issues in transcatheter aortic valve implantation. Part 2: procedural issues and outcomes after transcatheter aortic valve implantation[J ] . Eur Heart J, 2014, 35(38): 2639-2654. DOI:10.1093/eurheartj/ehu257.

AUFFRET V, PURI, URENA M, et al . Conduction disturbances after transcatheter aortic valve replacement: current status and future perspectives[J ] . Circulation, 2017, 136(11): 1049-1069. DOI:10.1161/CIRCULATIONAHA.117.028352.

PIAZZA N, ONUMA Y, JESSERUN E, et al . Early and persistent intraventricular conduction abnormalities and requirements for pacemaking after percutaneous replacement of the aortic valve[J ] . JACC Cardiovasc Interv, 2008, 1(3): 310-316. DOI:10.1016/j.jcin.2008.04.007.

HASSELL M E, HILDICK-SMITH D, DURAND E, et al . Antiplatelet therapy following transcatheter aortic valve implantation[J ] . Heart, 2015, 101(14): 1118-1125. DOI:10.1136/heartjnl-2014-307053.

RODÉS-CABAU J, MASSON J B, WELSH R C, et al . Aspirin versus aspirin plus clopidogrel as antithrombotic treatment following transcatheter aortic valve replacement with a balloon-expandable valve: the ARTE (aspirin versus aspirin + clopidogrel following transcatheter aortic valve implantation) randomized clinical trial[J ] . JACC Cardiovasc Interv, 2017, 10(13): 1357-1365. DOI:10.1016/j.jcin.2017.04.014.

LEFÈVRE T. Anticoagulation treatment after transcatheter aortic valve replacement: striking the right balance[J]. JACC Cardiovasc Interv, 2016, 9(16): 1718-1720. DOI:10.1016/j.jcin.2016.07.017.

CHAKRAVARTY T, SØNDERGAARD L, FRIEDMAN J, et al . Subclinical leaflet thrombosis in surgical and transcathet er bioprosthetic aortic valves: an observational study[J ] . Lancet, 2017, 389(10087): 2383-2392. DOI:10.1016/S0140-6736(17)30757-2.

RUILE P, JANDER N, BLANKE P, et al . Course of early subclinical leaflet thrombosis after transcatheter aortic valve implantation with or without oral anticoagulation[J ] . Clin Res Cardiol, 2017, 106(2): 85-95. DOI:10.1007/s00392-016-1052-3.

Views

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Cold versus hot snare polypectomy in treatment of small colorectal polyps: a retrospective study on safety and efficacy

Management of complications related to vascular access in endovascular abdominal aortic aneurysm repair: a retrospective analysis of 57 cases

Curative efficacy and safety of 2 surgical approaches in management of female stress urinary incontinence: a prospective randomized controlled trial

Etiological analysis of postoperative rectal mucosal prolapse in children after congenital anorectal malformation surgery

Influence of early left ventricular end-diastolic diameter improvement on prognosis of severe aortic valve stenosis patients after transcatheter aortic valve replacement

Related Author

Jinlong HE

Lei CHEN

Jing CHEN

Xiaofeng FENG

Yao CHEN

Qing JI

Dianchun FANG

Lixia DUAN

Related Institution

Department of Gastroenterology, First Affiliated Hospital, Army Medical University (Third Military Medical University)

Department of Vascular Surgery, the First Affiliated Hospital of Chongqing Medical University

Institute of Urology, Southwest Hospital, Third Military Medical University

Department of Gastrointestinal and Neonatal Surgery, Key Laboratory of Child Development and Disorders Co-founded by Chongqing and Ministry of Education, Chongqing International Science and Technology Cooperation Center for Child Development and Disoeders, Chongqing Key Laboratory of Pediatrics, Children's hospital of Chongqing Medical University

Department of Gastroenterology, Second Affiliated Hospital, Army Medical University (Third Military Medical University)

⁰