Przezcewnikowa implantacja zastawki aortalnej u pacjentów niskiego ryzyka
Streszczenie
Zabieg przezcewnikowej implantacji zastawki aortalnej (TAVI, transcatheter aortic valve implantation) jest jedną z najdokładniej badanych technologii medycznych ostatnich dwudziestu lat. Stał się on szansą dla pacjentów nieoperacyjnych, metodą preferowaną względem operacyjnej wymiany zastawki w grupie wysokiego ryzyka oraz alternatywą do leczenia chirurgicznego w grupie pośredniego ryzyka. Coraz więcej danych wskazuje na równorzędność TAVI względem wymiany chirurgicznej w grupie chorych niskiego ryzyka operacyjnego, szczególnie w obserwacji
krótkoterminowej, niemniej konieczne są dalsze obserwacje długoterminowe. Jest to istotne szczególnie z uwagi na młodszy wiek i szacowane dłuższe przeżycie pacjentów z grupy niskiego ryzyka. Jednym z głównych problemów w tej grupie chorych jest degeneracja implantowanej zastawki, która potencjalnie może wiązać się z koniecznością ponownej interwencji. Do innych problematycznych kwestii zaliczyć należy dostęp do tętnic wieńcowych po TAVI, znaczenie przecieku okołozastawkowego czy konieczność wszczepienia układu stymulującego. Długoterminowe badania obejmujące duże grupy pacjentów odpowiedzą na te pytania i wskażą kierunki dalszego rozwoju.
Słowa kluczowe: przezcewnikowa implantacja zastawki aortalnejchirurgiczna wymiana zastawki aortalnejstenoza aortalnastrukturalna degeneracja zastawki
Referencje
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