编者按：经导管主动脉瓣置入术（TAVI）已发展为重度主动脉瓣狭窄患者的标准治疗选择，但随着TAVI扩展到更年轻、低风险、预期寿命更长的患者，哪些患者应接受外科主动脉瓣置换术（SAVR），TAVI与SAVR的长期结局如何值得思考？ESC 2022大会上，本刊特邀法国巴斯德诊所Didier Tchetche教授进行了专访。

 

 

《国际循环》：作为“SAVR与TAVR终生管理的结局”专场主席，请介绍一下本专题的背景和意义？

 

Didier Tchetche教授：本次会议非常重要，因为它涉及我们所关注的当代问题。由于现在在欧洲被允许治疗比既往较年轻的瓣膜病变患者，因此出现了对这些患者进行终生管理的问题。无论选择SAVR还是TAVI，都会产生一定影响。本次会议是关于讨论各种治疗选择的利弊，整合患者的意愿、患者的背景以及预估患者未来的结局。

 

This session was a very important session because it deals with a contemporary concern that we have. As we are now allowed in Europe to treat slightly younger patients than we did in the past， the issue arises of the lifetime management of these patients. Whether it be surgery or TAVI， has consequences. This session was about discussing the pros and cons of the various options， integrating the will of the patient， the background of the patient， and what we anticipate to be the future outcomes for the patient.

 

《国际循环》：在患有重度主动脉瓣狭窄和慢性肾病的中危患者中，TAVI和SAVR的结局有何不同？

 

Didier Tchetche教授：这是一个非常重要的话题。众所周知，在中等风险患者中，TAVI与SAVR的结局相似，但当将肾功能问题纳入方程式时，会影响医生的选择。对于使用设备的肾功能衰竭患者，SAVR瓣膜退化更快，对于TAVI来说可能也是如此，因此需要将其与特定患者的预期寿命相结合。患者可能处于中等风险，但肾脏病变的程度（患者是否正在透析等）将对将要使用的平台预期耐用性产生影响。目前，在潜在的中危患者中，如果患者具有可能妨碍TAVI输送导管安全推进的外周血管疾病，则SAVR将是选择。否则，TAVI将是中危患者的更好选择。

 

This is quite an important topic. We know that in intermediate risk patients， TAVI has similar outcomes to surgery， but when we put into the equation the issue of renal function， this has an impact on our choices. For patients with renal failure who are going to have a device， for instance， a surgical valve that is going to degenerate faster， and maybe the same for TAVI， we need to integrate that with the life expectancy of the particular patient. They may be at intermediate risk， but the degree of the renal disease (whether the patient is on dialysis and so on) will have an impact on the anticipated durability of the platform that is going to be utilized. For the time being， potentially in intermediate risk patients， if we have peripheral vascular disease that may preclude safe advancement of the delivery catheter for TAVI， surgery would be the choice. Otherwise， TAVI would be the better choice for patients of intermediate risk.

 

《国际循环》：中危患者选择TAVI或SAVR时应考虑哪些因素？

 

Didier Tchetche教授：正如文献所证明的那样，在中危患者中经股动脉TAVI和SAVR的结局相似，它们产生相同的结果。因此，这归结为患者的解剖结构。在我们了解经股动脉解剖的地方，可以安全地使用TAVI治疗这部分患者。如果有更具挑战性的解剖结构，例如二叶主动脉瓣、升主动脉瘤、小主动脉根部、更具挑战性的外周血管系统，与TAVI相比，SAVR可能更具优势。

 

In intermediate risk patients， as proven by the literature， we know that outcomes are similar for transfemoral TAVI and surgery in intermediate risk patients. They produce the same outcomes. So it is going to come down to the anatomy of the patient. Where we understand the transfemoral anatomy， we know we can safely treat these patients with TAVI. If we have more challenging anatomy， such as， for instance， bicuspid aortic valves， ascending aorta aneurysms， small aortic roots， more challenging peripheral vasculature， then potentially surgery has advantages compared to TAVI.

 

 

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