经导管主动脉瓣置换术中瓣中瓣技术的应用进展

 随着社会老龄化的进展，主动脉瓣疾病的患病率显著上升。目前经导管主动脉瓣置换术（transcatheter aortic valve replacement，TAVR）已成为中高危主动脉狭窄患者的首选治疗方案，且其在主动脉瓣反流患者中的应用不断增加。受到个体解剖结构、血流动力学及不同瓣膜特点的影响，部分患者在TAVR术中接受首个瓣膜植入后的效果欠佳。经导管瓣中瓣置入术在TAVR初次效果不佳患者中的应用不断增加，且多项临床研究显示其即刻效果及短中期随访效果良好。本文就TAVR术中需要瓣中瓣置入的危险因素、瓣中瓣技术的预后及技术难点作一综述。

Research progress on valve-in-valve technique in transcatheter aortic valve replacement

Along with the coming of aged society,the prevalence of aortic valvular disease is significantly increasing.Nowadays,transcatheter aortic valve replacement (TAVR) has been established as the optimal treatment of aortic stenosis in the population with intermediate and high surgical risk.Moreover,TAVR has also been performed for pure aortic valve regurgitation.Whereas,ineffectiveness of the first valve still might occur confronted with individualized anatomical structure, hemodynamical characteristics and different valve types.Intraprocedural valve-in-valve deployment is increasingly applied in these patients undergoing TAVR with an unsatisfied first valve.The immediate and mid-term clinical and hemodynamic results have demonstrated its safety and feasibility.Here,we briefly review the risk factors in need for a second valve following TAVR, the prognosis and challenges in the valve-in-valve technique.