摘要
结构性瓣膜退化(SVD)是人工心脏瓣膜的自身组件发生内在不可逆的病理改变,表现为瓣膜纤维化、钙化、磨损、撕裂、松弛以及支架断裂或变形等,最终导致瓣膜狭窄和/或反流。经导管主动脉瓣置换术(TAVR)后出现SVD的发生机制可能与机械应力、免疫反应及钙磷代谢异常有关。TAVR后SVD的危险因素包括患者因素(如年龄、心血管基础疾病及其合并症)、瓣膜因素(如材料、处理方式、类型)和手术因素(如瓣膜损伤、支架扩张不良、支架释放形态不规则)。临床上影像学评估TAVR后SVD时,超声心动图、多排螺旋计算机断层扫描和心脏磁共振成像各有优势,评估目的也有不同。主要应对策略包括药物治疗、再次TAVR、外科主动脉瓣置换术(SAVR)及SURPLUS术。再次TAVR因其微创性成为常用方法,但仍需进一步明确患者适应证和优化手术策略;SAVR适用于年轻、低风险患者;SURPLUS术则结合了SAVR和TAVR的优点,适用于再次TAVR不可行或有禁忌证,同时SAVR风险过高者。本文就SVD在TAVR治疗背景中的最新研究进展进行综述,以期为生物瓣耐久性研究和临床干预SVD提供参考。
Structural valve deterioration(SVD)refers to intrinsic and irreversible pathological changes in the components of prosthetic heart valves,manifesting as fibrosis,calcification,wear and tear,loosening,as well as strut fracture or deformation of the valve framework.These changes ultimately lead to valve stenosis and/or regurgitation.The mechanisms may be related to mechanical stress,immune response and abnormal calcium-phosphorus metabolism.Studies have shown that risk factors for SVD include patient factors(such as age,underlying cardiovascular disease and comorbidities),valve factors(such as material properties,processing techniques,and valve type),and surgical factors(such as valve injury,suboptimal stent expansion,and irregular stent release morphology).Clinical imaging assessment of SVD demonstrates complementary advantages among echocardiography,multi-detector spiral CT and cardiac magnetic resonance imaging,with distinct diagnostic objectives.The primary management strategies for SVD after trans-catheter aortic valve replacement(TAVR)include drug therapy,redo-TAVR,surgical aortic valve replacement(SAVR)and the novel SURPLUS technique.Among them,redo-TAVR has become a common method because of its minimally invasive nature,but it is still necessary to further clarify the patient indications and optimize the surgical strategy.SAVR is reserved for young,low-risk patients;SURPLUS combines the advantages of SAVR and TAVR,making it suitable for cases where redo-TAVR is unfeasible or contraindicated,while the risk of SAVR is excessively high.This article reviews the latest progress of SVD following TAVR treatment to provide reference for research into the durability of bioprosthetic valve and clinical intervention of SVD.
作者
晏梦云
赵振刚
陈茂
YAN Mengyun;ZHAO Zhengang;CHEN Mao(Department of Cardiology,West China Hospital,Sichuan University,Chengdu 610041,China)
出处
《浙江大学学报(医学版)》
北大核心
2025年第2期183-190,共8页
Journal of Zhejiang University(Medical Sciences)
基金
四川省重大科技专项(2022ZDZX0030)
四川省干部保健科研项目(川干研ZH2024-103)。
关键词
主动脉瓣
经导管主动脉瓣置换术
生物瓣
结构性瓣膜退化
综述
Aortic valve
Transcatheter aortic valve replacement
Bioprosthetic valve
Structural valve deterioration
Review
