COMMENCE(SAVR)研究五年随访结果给中国主动脉瓣膜外科带来的思考  

Implications of five-year outcomes of COMMENCE(SAVR) trial for aortic valve surgery in China

作　　者：王春生[1] 陆树洋[1] WANG Chunsheng;LU Shuyang(Department of Cardiovascular Surgery,Zhongshan Hospital,Fudan University,Shanghai,200032,P.R.China)

机构地区：[1]复旦大学附属中山医院心脏外科,上海200032

出　　处：《中国胸心血管外科临床杂志》2021年第8期877-883,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金(81501595);上海市科技创新行动计划(20S31901800);复旦大学附属中山医院青年基金、人才培养基金、创新基金(2015ZSQN09,2017ZSYQ24,2017ZSCX05,2020ZSCX07)。

摘　　要：对于重度主动脉瓣病变的患者而言,经导管主动脉瓣置换术(TAVR)的诞生为之带来了全新治疗选择。然而,在手术适应证范围不断拓展的同时,生物瓣带来的结构性瓣膜衰败等问题逐渐凸显。最新公布的COMMENCE(SAVR)研究5年随访结果中,使用新型RESILIA生物组织材料的主动脉瓣生物瓣膜以零结构性瓣膜衰败、优异的血流动力学评估结果,展现了非凡的临床安全性、有效性和耐久性。瓣膜性心脏病患者因此拥有了更加多样化的治疗选择。然而,选择外科主动脉瓣置换术(SAVR)还是TAVR、生物瓣还是机械瓣等问题亦愈发突出,给临床医师带来了较多困扰。本文就COMMENCE研究背景、研究5年随访结果以及该研究给中国主动脉瓣膜外科带来的思考进行阐述。The advent of transcatheter aortic valve replacement(TAVR)has brought up a new treatment option for patients with severe aortic valve disease.However,with the continuous expansion of surgical indications,problems such as structural valve deterioration caused by biological prosthesis have become increasingly prominent.In the newly announced 5-year follow-up results of COMMENCE(SAVR)trial,the aortic bioprosthesis using the new RESILIA biotissue material demonstrated extraordinary clinical safety,efficacy and durability with zero structural valve deterioration and excellent hemodynamic evaluation results.As a result,patients with valvular heart disease have more diverse therapeutic options.However,the choice between surgical aortic valve replacement(SAVR)and TAVR,biological prosthesis and mechanical prosthesis,etc,has become more and more prominent,which brings more difficulties to clinicians.This paper reviews the research background,5-year follow-up results of COMMENCE trial and the implications for aortic valve surgery in China.

关 键 词：外科主动脉瓣置换术(SAVR) 经导管主动脉瓣置换术(TAVR) 结构性瓣膜衰败 COMMENCE研究 

分 类 号：R654.2[医药卫生—外科学]