经导管心脏瓣膜置换治疗的发展现状

Current Development Status in Transcatheter Heart Valve Replacement Therapy

摘要: 心脏瓣膜病已成为我国最常见的心脏疾病类型，且随着人口老龄化进程的加快，该病已对全球人类健康构成重大威胁。目前，手术治疗仍是治疗心脏瓣膜疾病最有效的手段。然而，约30%~50%的患者因高龄、合并多器官疾病或左心功能不全等因素被评估为外科手术的高风险或禁忌人群。在此背景下，经导管心脏瓣膜置换治疗逐渐成为心血管介入治疗的研究热点与临床难点，并在过去十年中取得了革命性进展。然而，该技术在应用过程中也伴随着一系列并发症，如瓣周漏、心包填塞等，若未能及时识别与处理，可能危及患者生命。随着瓣膜介入器材和技术的快速发展，如何科学筛选适应症患者、把握最佳治疗时机、应对术中突发状况以及优化围术期管理等问题，亟需进一步研究与规范。本文就近年来经导管心脏瓣膜置换治疗的发展现状进行系统综述。

Abstract: Valvular heart disease has become the most prevalent form of heart disease in China. As the global population continues to age, this condition has emerged as a significant threat to public health worldwide. Currently, surgical intervention remains the gold standard for treating valvular heart disease. Nevertheless, approximately 30% to 50% of patients are deemed high-risk or unsuitable candidates for surgery due to factors such as advanced age, comorbid multi-organ dysfunction, or impaired left ventricular function. In this context, transcatheter heart valve replacement has evolved into a key focus of cardiovascular interventional research and a major challenge in clinical practice, witnessing groundbreaking advancements over the past decade. However, the procedure is associated with several complications, such as paravalvular leakage and pericardial tamponade. If not identified and managed in a timely manner, these complications may endanger the patient’s life. With rapid innovations in interventional valve devices and procedural techniques, critical questions remain regarding patient selection, optimal timing of intervention, intraoperative emergency response, and perioperative care. These issues require further investigation and standardized guidelines. This article presents a systematic review of recent developments in transcatheter heart valve replacement therapy.