患者固有因子が経カテーテル大動脈弁人工弁選択に及ぼす影響

Transcatheter aortic valve (TAV) implantation is an established treatment strategy for patients with severe aortic stenosis across the spectrum of surgical risk profiles. Numerous randomised controlled trials have consistently demonstrated the safety and efficacy of TAV implantation compared with surgical aortic valve replacement, prompting an expansion of indications towards lower surgical risk, often younger, patients. In parallel, the number and types of TAV prosthesis have also increased. Although all devices have generally demonstrated favourable procedural and longer-term clinical outcomes, variations in frame design, material properties and leaflet configurations render specific devices more favourable in certain settings. In this review, we describe key differences in TAV design and how this may affect the choice of TAV prosthesis in the challenging clinical scenarios of patients with small annuli, coronary disease, long life expectancy, risk of permanent pacing and aortic regurgitation, which are expected to be encountered more frequently as indications for TAV implantation expand.