バイカスピッド対トリカスピッド大動脈狭窄と死亡率または脳卒中との関連
Raj R Makkar1, Sung-Han Yoon1, Martin B Leon2
1Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
JAMA
|June 12, 2019
まとめ
双管大動脈狭窄症の患者の経管大動脈弁置換 (TAVR) は,三管大動脈狭窄症と同様の死亡率を示しているが,脳卒中のリスクは高い. 双管大動脈狭窄に関するこれらの発見を確認するには,さらなるランダム化試験が必要である.
科学分野:
- 心血管医学
- 介入心臓科
- バイオメディカルエンジニアリング
背景:
- トランスキャテーター大動脈弁置換 (TAVR) の用例は拡大しています.
- 双管大動脈狭窄症の患者の数は増えています
- Pivotal TAVR試験では,双動脈の解剖を持つ患者を除外した.
研究 の 目的:
- 双頭筋と三頭筋大動脈狭窄症の患者における TAVR の結果を比較する.
- 双管大動脈狭窄患者群におけるTAVRの安全性と有効性を評価する.
主な方法:
- レジストリに基づく前向きなコホート研究
- STS/ACC トランスキャセターバルブセラピーのレジストリ (STS/ACC Transcatheter Valve Therapies Registry) から,2691人の傾向スコアがマッチした患者ペアの分析 (2015年6月〜2018年11月).
- 主なアウトカムには,30日および1年後の死亡率と脳卒中が含まれていた.
主要な成果:
- 30日または1年の全因死亡率では,二管大動脈狭窄群と三管大動脈狭窄群の間で有意な差はなかった.
- 30日間の脳卒中率は,双管大動脈狭窄群でかなり高かった (2. 5% 対 1. 6%).
- オープンハート手術を必要とする手術合併症のリスクが高くなった (0. 9% 対 0. 4%).
結論:
- 双大動脈狭窄症におけるTAVRは,同様の死亡率と関連しているが,三大動脈狭窄症と比較して脳卒中のリスクは増加している.
- バルブ血液動力学やパラバルブ漏れに重大な差異は認められなかった.
- 選択バイアスの可能性があるため,TAVRの有効性と安全性を完全に評価するには,ランダム化試験が必要である.
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