経カテーテル的大動脈弁置換術の現状と展望

Current Status and Future Perspective of Transcatheter Aortic Valve Replacement

大動脈弁狭窄症（aortic stenosis：AS）は，成因として先天性（二尖弁），リウマチ性，変性性（石灰化）があるが，高齢化社会の本邦においては変性性ASの割合がもっとも多い．本邦では75歳以上の中等症以上の大動脈弁疾患は約5％の有病率といわれており，さらなる高齢化に伴い，今後ますます患者数は増加してゆくと考えられる．

The number of patients eligible for transcatheter aortic valve replacement （TAVR） has expanded significantly since its initial approval in 2013, and a wealth of evidence has led to TAVR being considered for all patients with symptomatic severe aortic stenosis （AS）, based on the overall judgment of the heart team. Clinical results of TAVR in moderate- and low-risk patients, as well as in chronic hemodialysis patients, are expected to emerge in the coming years. We believe that the heart team, including cardiovascular surgeons and cardiologists, needs to be further matured to consider “life-time management” of each patient from various perspectives and comprehensively.