Treatment of Severe Aortic Valve Stenosis: Impact of Patient Sex and Life Expectancy on Treatment Choice.

IF 3.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS European Cardiology Review Pub Date : 2022-12-06 eCollection Date: 2022-02-01 DOI:10.15420/ecr.2022.31
Nina Rashedi, Catherine M Otto
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Abstract

In adults with severe aortic stenosis, sex and age differences in symptoms and diagnosis may lead to delays in intervention. Choice of intervention partly depends on expected longevity because bioprosthetic valves have limited durability, particularly in younger patients. Current guidelines recommend the following: a mechanical valve in younger adults (aged <50 years) if lifelong anticoagulation is possible and acceptable and a valve-sparing procedure is not possible; surgical mechanical or bioprosthetic aortic valve replacement (SAVR) in adults aged 50-65 years; and transcatheter aortic valve implantation (TAVI) for those aged >80 years based on lower mortality and morbidity compared to SAVR and adequate valve durability. For patients aged 65-80 years, the choice between TAVI and a bioprosthetic SAVR depends on expected longevity, which is greater in women than men, as well as associated cardiac and noncardiac conditions, valvular and vascular anatomy, estimated risk of SAVR versus TAVI and expected complications and patient preferences.

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严重主动脉瓣狭窄的治疗:患者性别和预期寿命对治疗选择的影响。
对于患有严重主动脉瓣狭窄的成人患者,症状和诊断方面的性别和年龄差异可能会导致介入治疗的延误。介入治疗的选择部分取决于预期寿命,因为生物人工瓣膜的耐久性有限,尤其是对年轻患者而言。目前的指南建议如下:与 SAVR 相比,机械瓣膜的死亡率和发病率较低,且瓣膜具有足够的耐久性,因此对于年轻的成年人(80 岁),建议使用机械瓣膜。对于 65-80 岁的患者,选择 TAVI 还是生物人工 SAVR 取决于预期寿命(女性的预期寿命高于男性)、相关的心脏和非心脏疾病、瓣膜和血管解剖、SAVR 与 TAVI 的估计风险、预期并发症以及患者的偏好。
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来源期刊
European Cardiology Review
European Cardiology Review CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
5.40
自引率
0.00%
发文量
23
审稿时长
12 weeks
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