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经导管主动脉瓣置换术的应用进展和并发症的分析
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Abstract:
经导管主动脉瓣置换术(Transcatheter Aortic Valve Replacement, TAVR)作为一种微创治疗手段，在重度主动脉瓣狭窄(Aortic Stenosis, AS)患者中的应用日益广泛。自2002年首次临床应用以来，TAVR技术不断优化，其适应证已从高危患者扩展至中低风险患者，甚至包括二叶式主动脉瓣(Bicuspid Aortic Valve, BAV)患者。近年来，瓣膜材料、输送系统及手术策略的创新进一步提升了TAVR的安全性和有效性。然而，TAVR仍然面临瓣周漏(Paravalvular Leak, PVL)、心脏传导阻滞及永久起搏器植入(Permanent Pacemaker Implantation, PPI)、卒中及冠状动脉阻塞等并发症的挑战，影响其长期预后。本文综述了TAVR的技术进展、适应证扩展、手术入路优化及并发症管理，并探讨了TAVR在低风险患者及BAV患者中的应用前景。随着新型瓣膜设计及围术期管理策略的优化，TAVR的长期疗效有望进一步改善，为更广泛的患者群体提供治疗选择。
Transcatheter aortic valve replacement (TAVR) has become an increasingly widespread minimally invasive treatment for patients with severe aortic stenosis (AS). Since its first clinical application in 2002, TAVR technology has continuously improved, and its indications have expanded from high-risk patients to include intermediate- and low-risk patients, as well as patients with bicuspid aortic valves (BAV). In recent years, innovations in valve materials, delivery systems, and surgical strategies have further enhanced the safety and efficacy of TAVR. However, TAVR still faces challenges such as paravalvular leak (PVL), heart block, permanent pacemaker implantation (PPI), stroke, and coronary artery obstruction, which impact its long-term outcomes. This review summarizes the technological advancements in TAVR, the expansion of indications, optimization of surgical approaches, and the management of complications, while exploring the future application of TAVR in low-risk patients and BAV patients. With the optimization of novel valve designs and perioperative management strategies, the long-term efficacy of TAVR is expected to improve, providing treatment options for a broader range of patient populations.
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