经导管瓣中瓣治疗生物瓣退化的现状及前景  

Status and prospect of transcatheter valve-in-valve implantation for biological valvedegeneration

作　　者：周亚雄 ZHOU Yaxiong(CardiMED Medical Technology Co.,Ltd.,Shanghai,201100,P.R.China)

机构地区：[1]上海卡地美得医疗科技有限公司,上海201100

出　　处：《中国胸心血管外科临床杂志》2024年第5期800-806,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：随着老龄化社会的到来,心脏瓣膜病的发病率显著增加。在过去20年中,治疗心脏瓣膜病变的生物瓣膜使用量大幅增加,预计在不久的将来,会有越来越多生物瓣膜退化患者。在这种情况下,瓣中瓣(valve-invalve,ViV)经导管主动脉瓣/二尖瓣置换术(transcatheter aortic/mitral replacement,TAVR/TMVR)已成为再次手术的替代方案。深入了解退化生物瓣膜的特征和机理对于制定适当的诊疗方案至关重要。多模式成像是评估诊断的基础。短中期临床和血流动力学结果已证明ViV技术的安全性,但这些技术的发展仍面临一些挑战,如冠状动脉阻塞、术后潜在患者-瓣膜失配和瓣叶血栓形成。本文综述了ViV-TAVR技术在治疗生物瓣退化中应用的现状和前景,建议ViV-TAVR应在具有良好外科主动脉瓣置换术经验的医疗中心推广和实施,以便为患者提供更好的治疗。Along with the coming of aged society,the prevalence of heart valvular disease is significantly increasing,and the use of bioprosthetic valves for treating patients with severe valve disease has increased over the last two decades.As a consequence,a growing number of patients with surgical bioprosthesis degeneration is predicted in the near future.In this setting,valve-in-valve(ViV)transcatheter aortic/mitral valve replacement(TAVR/TMVR)has emerged as an alternative to redo surgery.A deep knowledge of the mechanism and features of the failed bioprosthetic heart valve is pivotal to plan an adequate procedure.Multimodal imaging is fundamental in the diagnostic and pre-procedural phases.The immediate and mid-term clinical and hemodynamic results have demonstrated the safety and feasibility of ViV techniques,but the development of these techniques faces several specific challenges,such as coronary obstruction,potential post-procedural mismatch and leaflet thrombosis.This article reviews the current status and prospects of ViVTAVR technology in the treatment for biological valve degeneration,and suggests that ViV-TAVR should be promoted and implemented in existing medical centers with good surgical aortic valve replacement experience,so as to provide better treatment for patients.

关 键 词：经导管主动脉瓣置换术 瓣中瓣 生物瓣膜退化 球囊瓣膜重塑 综述 

分 类 号：R654.2[医药卫生—外科学]