Transcatheter 主动脉瓣 replacement, 或TAVR, is a minimally invasive 心 procedure that replaces a thickened 主动脉瓣 that can't fully open (主动脉瓣狭窄). The procedure restores proper blood circulation by inserting a replacement valve into the damaged valve.
” TAVR, you're essentially cured of 主动脉瓣狭窄," says Jason Glotzbach，医学博士, a cardiothoracic surgeon at University of Utah Health. "The patient's life expectancy and quality of life goes up right away. And unless there are other issues, their prognosis from a 心 standpoint is improved within a week or two."
The Aortic Valve and Stenosis
主动脉瓣狭窄 means narrowing of that valve opening, most often due to calcium buildup on the 主动脉瓣's leaflets. These leaflets are flaps of tissue that regulate the flow of blood through the 主动脉瓣. 而不是很好, 软, 柔软, 弹性传单, they become calcified and stiff, 几乎没有打开,Glotzbach说. When blood cannot properly eject from the 心, increased stress on the pumping chamber of the 心 causes symptoms.
Stenosis Risks and Diagnosis
"病人 usually have a 心杂音,Glotzbach说, "and the 主动脉瓣狭窄 murmur is one of the loudest, most classic murmurs in the 心. By the time you get moderate stenosis, the murmur is fairly prominent. A transthoracic echocardiogram is then used to confirm the diagnosis and determine the severity of stenosis."
Symptoms of severe 主动脉瓣狭窄 includes:
- 呼吸急促（气促）
- Fatigue with exertion
- Syncope—passing out with activity
- 晕倒
- 胸部疼痛
- 突然死亡
"Stenosis is a common cause of passing out,Glotzbach说, "because if the 主动脉瓣 gets tight enough, you literally can't get enough blood out to your brain to maintain consciousness."
Intervention Before Failure
"When we see severe echo measurements in a patient with symptoms, we usually recommend 主动脉瓣 replacement,Glotzbach建议道. "In the last decade or so, we've developed and rapidly adopted the transcatheter 主动脉瓣 replacement procedure—a completely different technique than the standard approach." TAVR patients typically go home the next day.
"There are risks with the procedure, 但如果没有治疗, half of those with severe stenosis will die within two years,Glotzbach说. “不幸的是, there are no medications, 饮食, 生活方式, or exercise regimens that can treat 主动脉瓣狭窄."
TAVR Surgery and Benefits
TAVR is not open-心 surgery. Instead, the new valve is crimped down on a special delivery device. "We insert that device through the femoral artery in the groin, using live x-ray as a guide,Glotzbach解释道. "There's much less recovery time"—one week compared to six to eight weeks—because there's no sternotomy incision, and the average stay in the hospital is one night."
TAVR has rapidly become the standard of care for patients with 主动脉瓣狭窄, with the new tissue valves lasting 10 to 15 years. 更持久的金属, 或者机械阀门, are used for traditional 主动脉瓣 replacement during open-心 surgery and may be best for younger patients.
Paying Attention and Follow Up
Follow-up physical exams and echocardiograms are recommended for patients with 主动脉瓣狭窄 every six to 12 months. That's because stenosis tends to get worse over time. "Someone with mild 主动脉瓣狭窄 in their 50s has a very high chance of it being moderate to severe by the time they're 80,Glotzbach说.
Stenosis can be insidious, and once you have symptoms it can get rapidly worse. "Some of our patients are stoic and in denial of symptoms and think, 'Oh, I'm just getting older,',Glotzbach说. "But don't ignore functional decline. If your stamina and energy levels are going down and you cannot do things without getting winded, 检查一下. TAVR may be able to help you."
Aortic Disease Treatment from the Aortic Disease Program
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