经导管主动脉瓣置换术的临床研究和应用进展

晋军

doi:10.16016/j.1000-5404.201906158

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经导管主动脉瓣置换术的临床研究和应用进展

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- 经导管主动脉瓣置换术的临床研究和应用进展
- Transcatheter aortic valve replacement: clinical researches and progress of application
- 第三军医大学学报 2019年41卷第19期页码：1873-1880
- 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：
  
  [晋军，博士，主任医师，教授，博士生导师。担任美国心脏病学会专家会员（FACC），亚洲心脏病学会理事，中华医学会心血管专业委员会大血管学组副组长，重庆市医学会内科学专业委员会主任委员，《中华心血管病杂志》编委。为重庆市首批医学领军人才和重庆市学术技术带头人。主持国家“十三五”重点研发项目等9项，军队重大、重点课题6项，重庆市重点及人才计划课题3项。担任中国国家科技计划项目评审专家、国家高原用氧军用标准制定组核心专家。获得国家科技进步二等奖1项，军队及省部级科技进步一等奖各1项，二等奖3项。发表论文60篇，其中SCI收录论文10余篇。主要从事冠心病的介入治疗、外周血管疾病及心脏瓣膜疾病的介入治疗方面的研究。E-mail：jjxqyy@163.comJIN Jun, E-mail: jjxqyy@163.com
- 基金信息：
  
  陆军军医大学临床技术创新培育项目(CX2019LC113);；陆军军医大学第二附属医院临床重大创新特色技术项目(2018JSLC0018)
- DOI：10.16016/j.1000-5404.201906158
  中图分类号： R540.46;R542.52
- 收稿：2019-06-21，
  
  修回：2019-08-31，
  
  纸质出版：2019-10-15
- 稿件说明：
移动端阅览
晋军. 经导管主动脉瓣置换术的临床研究和应用进展[J]. 第三军医大学学报, 2019,41(19):1873-1880.

Jun JIN. Transcatheter aortic valve replacement: clinical researches and progress of application[J]. Journal of Third Military Medical University, 2019, 41(19): 1873-1880.
晋军. 经导管主动脉瓣置换术的临床研究和应用进展[J]. 第三军医大学学报, 2019,41(19):1873-1880. DOI： 10.16016/j.1000-5404.201906158.

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

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