经皮主动脉瓣置换专家共识

严重主动脉瓣狭窄的治疗选择
• 一、外科AVR。 • 机械瓣。相对年轻患者。 • 生物瓣。常会发生生物瓣叶的钙化。在年
轻患者平均发生时间为10～12年，老年患 者平均发生时间为15～18年。 实际上，应用现代生物瓣，术后5年有95％ 的患者瓣膜仍然良好，不必再次手术；10 年时90％；15年时降为70％。
• With severe, symptomatic, calcific AS, AVR is the only effective treatment that improves symptoms and prolongs survival (30,31).
• 对于严重的、有症状的、钙化性主动脉瓣 狭窄，换瓣术是能够改善症状和延长生命 的唯一有效治疗方法。
Leabharlann Baidu
• Sapien valve
经皮主动脉瓣置换术
• （二）CoreValve (Figure 2) (Medtronic, Inc., Minneapolis, MN). 三片猪心包固定于 可自膨胀的镍钛合金支架上。
经皮主动脉瓣置换术
• CoreValve： It is available in 3 sizes—26 mm, 29 mm, and 31 mm. This valve has also continued to iterate, with the initial devices being 25French, but now 18-French delivery sheaths are used. This valve has only been used by a retrograde approach— either via transfemoral, subclavian, or direct aortic access.
经皮主动脉瓣置换术
• An estimated 40,000 patients have received TAVR worldwide. Multiple single and multicenter registries, and a single randomized trial, have documented favorable outcomes using a wide spectrum of endpoints, including survival, symptom status, quality of life, and need for repeat hospitalization.
严重主动脉瓣狭窄的治疗选择
• 外科手术AVR的限制性 • Despite substantial contemporary
experience with successful AVR in elderly patients, multiple series have documented that 30% to 40% of patients with severe AS do not undergo surgery owing to advanced age, LV dysfunction, multiple coexisting conditions, and patient preference or physician recommendation。
严重主动脉瓣狭窄的治疗选择
• 三、经皮主动脉瓣置换术Transcatheter Aortic Valve Replacement。TAVR。
经皮主动脉瓣置换术
• 历史：1992开始动物实验；2002年实现经 皮置入人体第一个可扩张的马心包支架瓣 膜。
• 之后多种TAVR瓣膜问世。
经皮主动脉瓣置换术
• Device Description： （一）Sapien valve (Figure 1) Edwards Life Sciences, Inc.,
Irvine, CA)：三瓣牛心包瓣固定在可球囊扩张的钴铬合金 支架上。 • The Sapien valve is available in 23-mm and 26-mm sizes in the United States and 23-mm, 26-mm, and 29mm sizes in Europe. The initial devices required a 22- or 24-French sheath for delivery of the prosthesis. Recent iterations (NovaFlex) have decreased this to 18French.
严重主动脉瓣狭窄的治疗选择
• 二、Balloon aortic valvuloplasty. • 预后较差。Restenosis or recoil of the aortic
valve usually occurs within 6 months. Patients treated with balloon aortic valvuloplasty alone have shown poor prognosis, with survival rates of 50% at 1 year, 35% at 2 years, and 20% at 3 years . In addition, serious complications due to balloon aortic valvuloplasty occur in 15% to 25% of patients。
历史背景
• 主动脉瓣狭窄常见于老年（﹥75岁）的主 动脉瓣钙化、风湿性心脏病和先天性二叶 瓣。
• 主动脉瓣狭窄会逐渐进展，左心室壁肥厚， 最终导致左心衰竭。
• 一旦出现症状，预后极差。从症状出现到 死亡的平均时间：心衰2年，昏厥3年，心 绞痛5年。药物治疗1、2年死亡率为25％、 50％。
严重主动脉瓣狭窄的定义
• 对于左心室收缩功能正常的患者： • 主瓣峰值血流速度>4.0 m/s (对应跨主瓣峰
值压差64 mm Hg), 平均压差>40 mm Hg, 或主瓣瓣口面积<1.0 cm2. • 考虑到患者体表面积不同，主瓣面积常用 体表面积指数表示，≤0.6 cm2/m2 作为严重 主瓣狭窄的标准.
严重主动脉瓣狭窄的治疗选择