主动脉瓣狭窄（AS）系主动脉瓣器质性病变致瓣口狭窄，使左心室向主动脉排血阻力增加，引起左心室压力增高并出现向心性肥厚。而主动脉压降低，可引起呼吸困难、心绞痛、昏厥等典型临床表现，若不进行治疗，患者病情进行性加重，可危及生命。主动脉瓣狭窄的病因包括先天性（主要是先天性主动脉瓣二叶畸形）、风湿性及钙化性。呼吸困难、心绞痛和昏厥为典型主动脉瓣狭窄常见的三联征，出现较晚[1]。
在西方国家，AS发病率在年龄≥65岁人群中约为2.0%，在年龄85岁人群中约为4.0%，是发病率仅次于冠心病和高血压病的心血管疾病[2-4]，已成为当今主动脉瓣置换的首要病因及老年人最常见的心脏瓣膜疾病。我国主动脉病流行病学特点明显不同于国外，国外主动脉瓣狭窄（AS）比主动脉瓣反流（AR）发病率高[5]，而我国则是主动脉瓣反流（AR）比主动脉瓣狭窄（AS）常见[6]。
严重主动脉瓣狭窄尚无有效的药物治疗，对于成年人钙化的瓣叶，行球囊扩张术仅能暂时改善症状，不能改善生存率[7]。人工主动脉瓣置换术是处理各种类型的主动脉瓣病变的干预金标准，根据最新的指南[8]：
1、如果可行，年龄>80岁或预期寿命<10年的患者首选经股动脉路径（TF）TAVR。
2、年龄65-80岁、无TF TAVR禁忌证的有症状患者，建议医生和患者共同决策，选择SAVR或TF TAVR。
Aortic valve replacement is a recommended treatment for acquired valve diseases, while TAVR, as a new minimally invasive surgery, is highly safe and gradually expands its indications [1]. According to the intervention model for aortic valve opening, the valves are classified into balloon-expandable valves, self-expanding valves and mechanically expandable valves. The working principle is to compress the interventional valve on the delivery system, deliver it to the position where the valve is to be treated, and repair or replace the valve under the guidance of ultrasound or X-ray, so as to achieve the therapeutic purpose [2].
References
[1] 葛均波,周达新,潘文志, 等.《经导管心脏瓣膜治疗术 第2版》. 上海科学技术出版社,2019.
[2] Stewart BF, Siscovick D, Lind BK, et al. Clinical factors associated with calcific aortic valve disease:Cardiovascular Health Study. J Am Coll Cardiol, 1977, 29:630-634.
[3] Otto CM, Link BK, Kitzman DW, et al. Association of aortic-valve sclerosis with crdiovascular mortality and morbidity in the elderly.N Engl J Med, 1999, 341:142-147.
[4] Nkomo VT, Gardin JM, Skelton TN, et al. Burden of valvular heart diseases:a population-based study.Lancent,2006,368:1005-1011.
[5] Pan W, Zhou D, Cheng L, et al. Candidates for transcatheter aortic valve implantation may be fewer in china. Int JCardiol,2013,168:e133-134.
[6] Pan W, Zhou D, Cheng L, et al. Aortic regurgitation is more prevalent than aortic stenosis in Chinese elderly population:implications for transcatheter aortic valve replacement , Int J Cardiol, 2015,201:547-548.
[7] Otto CM, Mickel MC, Kennedy JW, et al. Three-year outcome after balloon aortic valvuloplasty. Insights into prognosis of valvular aortic stenosis [J].Circulation,1994, 89: 642-650.
[8] 中国医师协会心血管内科医师分会结构性心脏病专业委员会.中国经导管主动脉瓣置换术临床路径专家共识（2021 版）.中国循环杂志, 2022, 37: 12-22. DOI: 10.3969/j.issn.1000-3614.2022.01.003.
References
[1]葛均波. 中国心血管医疗器械产业创新白皮书 2021. 中国心血管医生创新俱乐部.
[2]葛均波，周达新，潘文志.《经导管瓣膜治疗术》. 上海科技出版社。2013年第一版，2019第二版。
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