重度の症状性大動脈弁縮小のために隔離された介入または外科的大動脈弁インプラントを施した中期的な外科リスクを有する患者
Nicolas Werner1, Ralf Zahn2, Andreas Beckmann3
1Medizinische Klinik B, Klinikum Ludwigshafen, Germany (N.W., R.Z.).
Circulation
|December 21, 2018
まとめ
トランスキャテーターによる大動脈弁置換 (TAVR) と手術による大動脈弁置換 (SAVR) は,中等リスクの患者の入院死亡率に類似した. TAVRとSAVRの1年後の死亡率は有意に異なっており,比較可能な結果を示唆しています.
科学分野:
- 心臓病科
- 介入心臓科
- 心臓外科
背景:
- トランスキャテーター大動脈弁置換 (TAVR) は,中等リスクの患者の重度の大動脈狭窄症にますます使用されています.
- この集団におけるTAVRと手術による大動脈弁置換 (SAVR) を比較する実際のデータは限られている.
研究 の 目的:
- 隔離されたTAVRとSAVRを受けた中等リスク患者の臨床的特徴とアウトカムを比較する.
- TAVRの安全性と有効性をSAVRと比較して,実際の環境で評価する.
主な方法:
- ドイツの大動脈弁の登録から7613人の患者の分析 (2012年−2014年).
- 患者は隔離されたTAVR (n=6469) またはSAVR (n=1144) を受け,中間の手術リスク (STSスコア4% - 8%) を受けた.
- 傾向スコアのマッチングは,ベースラインの差を調整するために使用されました.
主要な成果:
- TAVR患者は高齢で,SAVR患者よりも基値リスクスコアが高い.
- TAVRとSAVRの両方の入院死亡率は類似した (3. 6%).
- 調整されていない1年間の死亡率はTAVR (17. 5%) の後に高かったが,傾向スコアのマッチング (17. 1% vs 15. 7%) の後に有意な違いはなかった.
結論:
- TAVRを投与された中等リスクの患者は,SAVRを投与された患者とは,年齢とベースラインの特徴で有意に異なる.
- TAVRとSAVRの両方では,病院での死亡率が類似していることが示されました.
- TAVRとSAVRの1年間の死亡率は有意な違いを示せず,長期的に比較可能な結果を示唆した.
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