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经导管主动脉瓣置换

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The Year in Cardiovascular Medicine 2020: Valvular Heart Disease: Discussing the Year in Cardiovascular Medicine for 2020 in the field of valvular heart disease is Professor Helmut Baumgartner and Dr Javier Bermejo. Mark Nicholls reports Transcatheter versus Surgical Aortic Valve Replacement in Patients with Prior Cardiac Surgery in the Randomized PARTNER 2A Trial Prevalence and Outcomes of Concomitant Aortic Stenosis and Cardiac Amyloidosis Relationship Between Hospital Surgical Aortic Valve Replacement Volume and Transcatheter Aortic Valve Replacement Outcomes Cardiovascular Magnetic Resonance as a complementary method to Transthoracic Echocardiography for Aortic Valve Area Estimation in patients with Aortic Stenosis: A systematic review and meta-analysis Thrombotic Versus Bleeding Risk After Transcatheter Aortic Valve Replacement: JACC Review Topic of the Week Health Status After Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients With Aortic Stenosis Chimney technique in a TAVR-in-TAVR procedure with high risk of left main artery ostium occlusion Discrepancies in Measurement of the Thoracic Aorta: JACC Review Topic of the Week Cardiac Structural Changes After Transcatheter Aortic Valve Replacement: Systematic Review and Meta-Analysis of Cardiovascular Magnetic Resonance Studies
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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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