摘要
经导管主动脉瓣置换术(TAVR)已成为治疗重度主动脉瓣狭窄的标准方法,并在中、低危患者中取得了与传统手术相当的疗效。然而,TAVR所用生物瓣使用寿命有限,术后可能发生钙化、撕裂或感染等生物瓣衰败并发症,后者与患者不良预后密切相关。动脉血压升高是主动脉瓣钙化和生物瓣衰败的重要因素。高血压通过增加瓣膜机械应力、激活肾素-血管紧张素系统和促进血栓形成等机制可能加速钙化进程并加重生物瓣衰败。此外,动脉血压升高还与人工瓣膜-患者不匹配和瓣周漏等并发症相互作用,共同影响瓣膜耐久性。本文探讨了动脉血压升高影响TAVR后生物瓣钙化及衰败的机制,强调控制血压、优化术前评估和选择合适瓣膜类型在减少生物瓣衰败中的重要性,以期为临床实践提供指导。
Transcatheter aortic valve replacement(TAVR)has emerged as the standard treatment for severe aortic stenosis,demonstrating comparable efficacy to traditional surgery in low and intermediate-risk patients.However,the bioprosthetic valves utilized in TAVR have a limited lifespan,and bioprosthetic valve failure,including calcification,rupture or infection may develop,leading to poor clinical outcomes.Elevated blood pressure has been identified as a key factor in aortic valve calcification,and its role in bioprosthetic valve failure is gaining increasing attention.Hypertension may accelerate the calcification process and exacerbate valve failure due to increased mechanical stress on the valve,activation of the renin-angiotensin system,and enhanced thrombus formation.Furthermore,elevated blood pressure interacts with prosthesis mismatch and paravalvular leak,jointly affecting valve durability.This review explores the impact of elevated blood pressure on bioprosthetic valve calcification and failure after TAVR,and emphasizes the importance of blood pressure control,optimized preoperative assessment,and appropriate valve selection in reducing valve failures.
作者
绳文静
朱齐丰
戴晗怡
周道
刘先宝
SHENG Wenjing;ZHU Qifeng;DAI Hanyi;ZHOU Dao;LIU Xianbao(Department of Cardiology,the Second Affiliated Hospital,Zhejiang University School of Medicine,State Key Laboratory of Transvascular Implantation Devices,Hangzhou 310009,China;Zhejiang Provincial Key Laboratory of Cardiovascular Disease Diagnosis and Treatment,Hangzhou 310009,China;Binjiang Institute of Zhejiang University,Hangzhou 310053,China)
出处
《浙江大学学报(医学版)》
北大核心
2025年第2期154-160,共7页
Journal of Zhejiang University(Medical Sciences)
基金
浙江省自然科学基金(LQ22H020008)
国家重点研发计划(2020YFC2008100)
浙江大学滨江研究院自研项目(ZY202205SMKY001)
浙江省“尖兵”“领雁”研发攻关计划(2022C03063)。
关键词
生物瓣钙化
生物瓣衰败
经导管主动脉瓣置换术
动脉血压升高
综述
Bioprosthetic valves calcification
Bioprosthetic valve failure
Transcatheter aortic valve replacement
High artery blood pressure
Review
