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Challenges and opportunities in improving left ventricular remodelling and clinical outcome following surgical and trans-catheter aortic valve replacement

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Frontiers of Medicine 2021年第3期15卷 416-437页

作者： Xu Yu Jin Mario Petrou Jiang Ting Hu Ed D Nicol John R Pepper Surgical Echo-Cardiology Services Oxford Heart CentreJohn Radcliffe HospitalOxford University Hospitals NHS Foundation TrustOxford OX39DUUK Cardiac Surgical Physiology and Genomics Group Nuffield Division of Clinical Laboratory SciencesRadcliffe Department of MedicineUniversity of OxfordOxford OX39DUUK Department of Cardiac Surgery Royal Brompton HospitalLondon SW36NPUK National Heart and Lung Institute Imperial College LondonLondon SW36LYUK NIHR Imperial Biomedical Research Centre London W21NYUK Department of Cardiology Royal Brompton HospitalLondon SW36NPUK

Over the last half century,surgical aortic valve replacement(SAVR)has evolved to offer a durable and efficient valve haemodynamically,with low procedural complications that allows favourable remodelling of left ventricular(LV)structure and *** latter has become more challenging among elderly patients,particularly following trans-catheter aortic valve implantation(TAVI).Precise understanding of myocardial adaptation to pressure and volume overloading and its responses to valve surgery requires comprehensive assessments from aortic valve energy loss,valvular-vascular impedance to myocardial activation,force-velocity relationship,and myocardial *** hypertrophy and myocardial fibrosis remains as the structural and morphological focus in this *** intervention in asymptomatic aortic stenosis or regurgitation along with individualised management of hypertension and atrial fibrillation is likely to improve patient *** pacing via the his-purkinje system for conduction abnormalities,further reduction in para-valvular aortic regurgitation along with therapy of angiotensin receptor blockade will improve patient outcome by facilitating hypertrophy regression,LV coordinate contraction,and global vascular *** leaflet thromboses require anticoagulation while impaired access to coronary ostia risks future TAVI-in-TAVI or coronary *** comparable long-term durability and the resolution of TAVI related complications become available,SAVR remains the first choice for lower risk younger patients.

关键词： surgical aortic valve replacement trans-catheter aortic valve implantation left ventricular hypertrophy and fibrosis myocardial force-velocity relationship his-purkinje pacing renin-angiotensin system inhibitors coronary access impairment

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