Aortic stenosis (AS) refers to aortic valve narrowness due to organic lesions of the heart's aortic valve. This restricts the blood flow from the left ventricle to the aorta, resulting in elevated left ventricular pressure and centripetal hypertrophy. It can also lead to decreased aortic pressure, with common symptoms including dyspnea, angina pectoris and syncope. If no treatment is provided, the patient's condition may worsen and become life-threatening. The etiology of aortic stenosis includes congenital factors (mainly congenital bicuspid aortic valve disease), rheumatism and calcification. Dyspnea, angina pectoris, and syncope are the common triad in typical aortic stenosis, which often occurs at a later stage [1].
In western countries, the incidence of AS is about 2.0% in people aged ≥65 and about 4.0% in people aged 85. It is a cardiovascular disease with a high incidence rate, second only to coronary heart disease and hypertension [2-4]. It has become the primary cause of aortic valve replacement and the most common heart valve disease among elderly. The epidemiological characteristics of aortic diseases in China are distinctly different from those in foreign countries. The incidence of aortic stenosis (AS) in foreign countries is higher than that of aortic regurgitation (AR) [5], while in China, aortic regurgitation (AR) is more common than aortic stenosis (AS) [6].
There is no effective medication for severe aortic stenosis. For calcified leaflets in adults, balloon dilatation can only temporarily improve symptoms, but not the survival rate [7]. Artificial aortic valve replacement is the gold standard of intervention for various types of aortic valve lesions. According to the latest guidelines [8].
1. If feasible, transfemoral (TF) TAVR is preferred for patients aged >80 or with a life expectancy of <10 years.
2. For symptomatic patients aged 65-80 without TF TAVR contraindications, it is recommended that the doctor and the patient make a joint decision between SAVR and TF TAVR.
3. If the expected survival after intervention is >12 months and the quality of life is deemed acceptable, TAVR is preferred for patients of any age with symptoms, high surgical risk, or surgical contraindications.
Aortic valve replacement is a recommended treatment for acquired valve diseases, while TAVR, as a new minimally invasive surgery, is highly safe and gradually expands its indications [1]. According to the intervention model for aortic valve opening, the valves are classified into balloon-expandable valves, self-expanding valves and mechanically expandable valves. The working principle is to compress the interventional valve on the delivery system, deliver it to the position where the valve is to be treated, and repair or replace the valve under the guidance of ultrasound or X-ray, so as to achieve the therapeutic purpose [2].
References
[1] 葛均波,周达新,潘文志, 等.《经导管心脏瓣膜治疗术 第2版》. 上海科学技术出版社,2019.
[2] Stewart BF, Siscovick D, Lind BK, et al. Clinical factors associated with calcific aortic valve disease:Cardiovascular Health Study. J Am Coll Cardiol, 1977, 29:630-634.
[3] Otto CM, Link BK, Kitzman DW, et al. Association of aortic-valve sclerosis with crdiovascular mortality and morbidity in the elderly.N Engl J Med, 1999, 341:142-147.
[4] Nkomo VT, Gardin JM, Skelton TN, et al. Burden of valvular heart diseases:a population-based study.Lancent,2006,368:1005-1011.
[5] Pan W, Zhou D, Cheng L, et al. Candidates for transcatheter aortic valve implantation may be fewer in china. Int JCardiol,2013,168:e133-134.
[6] Pan W, Zhou D, Cheng L, et al. Aortic regurgitation is more prevalent than aortic stenosis in Chinese elderly population:implications for transcatheter aortic valve replacement , Int J Cardiol, 2015,201:547-548.
[7] Otto CM, Mickel MC, Kennedy JW, et al. Three-year outcome after balloon aortic valvuloplasty. Insights into prognosis of valvular aortic stenosis [J].Circulation,1994, 89: 642-650.
[8] 中国医师协会心血管内科医师分会结构性心脏病专业委员会.中国经导管主动脉瓣置换术临床路径专家共识（2021 版）.中国循环杂志, 2022, 37: 12-22. DOI: 10.3969/j.issn.1000-3614.2022.01.003.
References
[1]葛均波. 中国心血管医疗器械产业创新白皮书 2021. 中国心血管医生创新俱乐部.
[2]葛均波，周达新，潘文志.《经导管瓣膜治疗术》. 上海科技出版社。2013年第一版，2019第二版。
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