TAVR と SAVR の後の義肢弁内膜炎: PARTNER 試験からの洞察
Matthew R Summers1, Martin B Leon2, Craig R Smith2
1Cleveland Clinic Foundation, OH (M.R.S., S.R.K., E.M.T., L.S., P.C.C., W.A.J.).
Circulation
|November 7, 2019
まとめ
義肢弁内膜炎 (PVE) は,トランスキャテーターまたは手術による大動脈弁置換後にまれですが,死亡率を大幅に増加させます. TAVR と SAVR の間では,発生率,危険因子,および PVE のタイミングが似ており,警戒の必要性を強調しています.
科学分野:
- 心血管医学
- 感染症
- 医療機器技術
背景:
- 義肢弁内膜炎 (PVE) は,大動脈弁置換 (AVR) の後の重大な合併症であり,トランスキャテーター (TAVR) と外科手術 (SAVR) の両方に影響を及ぼします.
- PVEの発生率,危険因子,およびアウトカムを理解することは,多様な患者集団でTAVRの使用が増加していることから極めて重要です.
研究 の 目的:
- TAVRまたはSAVRを受けた患者におけるPVEの発生率,危険因子,微生物学的プロファイル,およびアウトカムを特徴づける.
- TAVRとSAVRのアプローチのPVE率と特性を比較する.
主な方法:
- TAVRまたはSAVRで治療された重度の大動脈狭窄症の患者を含むPARTNER試験とレジスタリから集められたコホートの分析.
- 修正されたデューク基準を用いたPVE判定で,発生率,タイミング,病原体,全因死亡率との関連が分析されています.
主要な成果:
- PVEは8530人の患者の1. 3%で発生した (人当たり1000人当たり5. 06) で,TAVRとSAVRの発生率は類似した.
- 発症時の肝硬変,肺疾患,腎不全はPVEのリスク増加と関連していました.
- PVEは全因死亡率と強く関連しており (HR,4. 4),SAVRの後にスタフィロコクスがより一般的であった.
結論:
- PVEは現代のAVRに続く希少だがしばしば致命的な合併症であり,TAVRとSAVRの発生率や予測因子の有意な違いはありません.
- これらの結果は,処置の種類に関係なく,すべてのAVR患者におけるPVEのモニタリングの重要性を強調しています.
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