浙江大学学报（医学版）2025，Vol.54Issue(2)：175-182,8.DOI:10.3724/zdxbyxb-2024-0458
经导管主动脉瓣置换术中冠状动脉阻塞风险及保护策略
Risk of coronary obstruction and protection strategies in transcatheter aortic valve replacement
摘要
Abstract
Transcatheter aortic valve replacement(TAVR)has emerged as the first-line treatment for aortic valve stenosis.Coronary obstruction is a severe complication of TAVR,with mortality rates exceeding 30%.Coronary obstruction can be classified as acute or delayed based on the timing of the onset,and as direct or indirect obstruction according to the underlying mechanism.Risk factors for predicting coronary obstruction include a small sinus of Valsalva diameter,excessively long native leaflets,low coronary height,and small sinotubular junction height and diameter.Accurate preoperative assessment of these anatomical parameters using CT is crucial for selecting the appropriate valve type,size,and implantation depth.Preventive technical strategies for coronary obstruction include intraoperative interventional treatments(such as the"Chimney"stenting technique),leaflet modification(such as the BASILICA technique),and alignment of the annulus and coronaries.These techniques have demonstrated significant efficacy in reducing the incidence of coronary obstruction and associated mortality.This paper reviews the epidemiology,classification,and mechanisms of coronary obstruction,with a particular focus on the identification,prevention,and treatment of high-risk patients.The aim is to highlight the importance of recognizing and managing coronary risks during TAVR and to provide actionable recommendations for the prevention and treatment of coronary obstruction in clinical practice.关键词
经导管主动脉瓣置换术/冠状动脉阻塞/烟囱支架技术/BASILICA技术/综述Key words
Transcatheter aortic valve replacement/Coronary obstruction/Chimney stent technique/BASILICA technique/Review分类
医药卫生引用本文复制引用
彭彦人,聂如琼,张海峰..经导管主动脉瓣置换术中冠状动脉阻塞风险及保护策略[J].浙江大学学报（医学版）,2025,54(2):175-182,8.基金项目
国家自然科学基金(82371573) （82371573）
广东省自然科学基金(2021A1515012042)This work was supported by the National Natural Science Foundation of China(82371573)and Natural Science Foundation of Guangdong Province(2021A1515012042) （2021A1515012042）
