Aortic regurgitation (AR) refers to the reverse flow of blood from the aorta into the left ventricle during diastole caused by incomplete closure of the aortic valve. Pathological causes of aortic regurgitation include valvular degeneration and aortic root dilation (with or without involvement of the mitral valve), rheumatic fever, aortic root dissection, Marfan syndrome, or rheumatic diseases [1]. Acute aortic regurgitation may cause heart failure and cardiogenic shock. Chronic aortic regurgitation is generally asymptomatic and latent for many years, while its symptoms such as exertional dyspnea, orthopnea, paroxysmal nocturnal dyspnea and palpitations will gradually become more noticeable.
A China-DVD study has shown that AR ranks third among diseases in elderly patients over 60 years of age (22.9%), much higher than the prevalence of AS (6.39%) [2]. AR patients experience a long symptom-free period and are usually old when they show clinical symptoms due to cardiac decompensation, with an incidence of severe heart failure at about 50%. Only 20% of patients with severe AR and LVEF at 30% to 50% have received SAVR, while only 3% of patients with LVEF <30% have received SAVR [3].
Similar to AS, Chinese and foreign researchers have also begun to explore the feasibility of TAVR in AR patients with high surgical risk, such as symptomatic AR patients or asymptomatic AR patients but with left ventricular dysfunction. In clinical practice, aortic insufficiency is still treated mainly by conventional surgery through valve replacement or valve repair, to correct abnormal cardiac structures and improve the prognosis. At present, aortic valve replacement or repair is performed, while the clinical effects of percutaneous aortic valve replacement are being evaluated [1].
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.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] 齐喜玲,许海燕,刘庆荣,吴永健.中国老年退行性心脏瓣膜病住院患者诊疗现状分析.中国循环杂志.2019;34(8):771-6.doi: 10.3969/j.issn.1000-3614.2019.08.007.
[3] Iung B, Baron G, Butchart EG, Delahaye F, Gohlke-Barwolf C,Levang OW, et al. A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease. Eur Heart J. 2003;24(13):1231-43.doi:10.1016/s0195-668x(03)00201-x.PubMed PMID: 12831818.
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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