JAMA Clinical Guidelines Synopsis March 25, 2019

Management of Patients With Severe Aortic Stenosis With Transcatheter Valve Replacement

AbdulRahman Dia, Adam S. Cifu, Atman P. Shah

JAMA. 2019;321(15):1527-1528. doi:10.1001/jama.2019.1336

Guideline title 指南标题

2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease

2014 AHA/ACC 心脏瓣膜病患者诊治指南的2017针对性更新

Release date 发布日期

June 20, 2017

Developers 制订者

American College of Cardiology (ACC)/American Heart Association (AHA)

Funding sources 资金来源

ACC and AHA

Target population 目标人群

Adult patients with severe aortic stenosis

主动脉瓣重度狭窄的成年患者

Major recommendations and ratings 主要推荐意见及级别

• Among patients for whom transcatheter valve replacement (TAVR) or high-risk surgical aortic valve replacement (SAVR) is being considered, a heart valve team should establish a management plan (strong recommendation; level of evidence, C [based on limited studies]). 对于考虑进行TAVR或高危主动脉瓣置换外科手术(SAVR)的患者，心瓣膜团队应当制定诊疗计划（强推荐；证据级别，C [基于有限研究]）]
• Surgical AVR or TAVR is recommended for symptomatic patients with severe aortic stenosis and at high risk (strong recommendation; level of evidence, A [benefit strongly exceeds risk based on long-term outcomes from multiple randomized clinical trials {RCTs}]). 推荐外科AVR或TAVR用于有临床症状的重度主动脉瓣狭窄及高危患者（强推荐；证据级别，A [基于多个RCTs的长期预后，获益远超风险]）
• Transcatheter AVR is recommended for symptomatic patients with severe aortic stenosis and a prohibitive risk for SAVR who have a predicted post-TAVR survival greater than 12 months (strong recommendation; level of evidence, A [based on long-term outcomes from multiple RCTs]). 经导管AVR推荐用于有临床症状的重度主动脉瓣狭窄及有SAVR禁忌症且预期TAVR后存活超过12个月的患者（强推荐；证据级别，A [基于多个RCTs的长期预后]）
• Transcatheter AVR is a reasonable alternative to SAVR for symptomatic patients with severe aortic stenosis and an intermediate surgical risk (moderate recommendation; level of evidence, B-R [limited populations studied in RCTs]). 对于有临床症状的重度主动脉瓣狭窄且有即刻手术风险的患者，经导管AVR是合理选择（中等程度推荐；证据级别，B-R [RCTs研究人群有限]）
• Transcatheter AVR is not recommended in patients for whom life expectancy would preclude the expected benefit from correction of aortic stenosis (strong recommendation; level of evidence, B-R [limited RCTs]). 经导管AVR不推荐用于预期生存较短，无法从纠正主动脉瓣狭窄获益的患者（强推荐；证据级别，B-R [有限RCTs]）