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

查看全文 作　　者：Xu Yu [1,2]Jin;Mario [3,4]Petrou;Jiang Ting [2]Hu;Ed D [4,6]Nicol;John R [3,4,5]Pepper 高影响力作者 机构地区：[1]Surgical Echo-Cardiology Services,Oxford Heart Centre,John Radcliffe Hospital,Oxford University Hospitals NHS Foundation Trust,Oxford OX39DU,UK;[2]Cardiac Surgical Physiology and Genomics Group,Nuffield Division of Clinical Laboratory Sciences,Radcliffe Department of Medicine,University of Oxford,Oxford OX39DU,UK;[3]Department of Cardiac Surgery,Royal Brompton Hospital,London SW36NP,UK;[4]National Heart and Lung Institute,Imperial College London,London SW36LY,UK;[5]NIHR Imperial Biomedical Research Centre,London W21NY,UK;[6]Department of Cardiology,Royal Brompton Hospital,London SW36NP,UK高影响力机构 出　　处：《Frontiers of Medicine》索引2021年第15卷第3期,共22页高影响力期刊 基　　金：The authors received financial support for the research work in cardiac physiology and aortic valve surgery by research grant from Garfield Weston Trust,London(to Xu Yu Jin and John R Pepper);from Oxford Hospital Charity,Oxford(to Xu Yu Jin). 摘　　要：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 function.The 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 strain.LV hypertrophy and myocardial fibrosis remains as the structural and morphological focus in this endeavour.Early intervention in asymptomatic aortic stenosis or regurgitation along with individualised management of hypertension and atrial fibrillation is likely to improve patient outcome.Physiological 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 function.TAVI leaflet thromboses require anticoagulation while impaired access to coronary ostia risks future TAVI-in-TAVI or coronary interventions.Until 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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