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经导管主动脉瓣置换

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Comparison of Early Surgical or Transcatheter Aortic Valve Replacement Versus Conservative Management in Low-Flow, Low-Gradient Aortic Stenosis Using Inverse Probability of Treatment Weighting: Results From the TOPAS Prospective Observational Cohort Study Right ventricular function and outcome in patients undergoing transcatheter aortic valve replacement 2020 ACC Expert Consensus Decision Pathway on Management of Conduction Disturbances in Patients Undergoing Transcatheter Aortic Valve Replacement A Report of the American College of Cardiology Solution Set Oversight Committee Short Length of Stay After Elective Transfemoral Transcatheter Aortic Valve Replacement Is Not Associated With Increased Early or Late Readmission Risk Decline in Left Ventricular Ejection Fraction During Follow-Up in Patients With Severe Aortic Stenosis Transcatheter Aortic Valve Replacement: Role of Multimodality Imaging in Common and Complex Clinical Scenarios Contemporary Presentation and Management of Valvular Heart Disease: The EURObservational Research Programme Valvular Heart Disease II Survey Ascending Aortic Length and Risk of Aortic Adverse Events: The Neglected Dimension Left Ventricular Hypertrophy and Clinical Outcomes Over 5 Years After TAVR: An Analysis of the PARTNER Trials and Registries 5-Year Outcomes Comparing Surgical Versus Transcatheter Aortic Valve Replacement in Patients With Chronic Kidney Disease
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GuidelineJuly 21, 2021

JOURNAL：JAMA Cardiol. Article Link

Guideline Update on Indications for Transcatheter Aortic Valve Implantation Based on the 2020 American College of Cardiology/American Heart Association Guidelines for Management of Valvular Heart Disease

TM Sundt; H Jneid et al. Keywords: TAVR; valular heart disease; indication; guideline

ABSTRACT

The continued evolution of transcatheter aortic valve implantation (TAVI) technology and the results of multiple randomized clinical trials (RCTs) have firmly established this approach as an alternative to surgical aortic valve replacement (SAVR) in the treatment of aortic stenosis in all risk groups. Deciding on TAVI or SAVR depends on patient-specific factors, including technical, procedure-specific contraindications and the balance between estimated life expectancy and anticipated prosthesis durability. These factors pertain to the decision between mechanical and biological prostheses, and if the choice is biological, between SAVR and TAVI. A strong emphasis is now placed on shared decision-making with the patient and involvement of the multidisciplinary heart team. For most patients younger than 65 years, SAVR is recommended, with mechanical valves favored in those younger than 50 years. For those older than 65 years, the perioperative risks of mortality and stroke are lower with transfemoral TAVI compared with SAVR, but the risks of paravalvular leak, a pacemaker requirement, and vascular complications are higher.
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