65歳未満の重度の大動脈狭窄症患者の単体および併用大動脈弁置換の傾向
Tanush Gupta1, James T DeVries2, Hsiang-Ching Huang2
1Division of Cardiology, University of Vermont Medical Center, Burlington, Vermont, United States.
Structural heart : the journal of the Heart Team
|September 2, 2025
まとめ
経管大動脈弁置換 (TAVR) の使用は,大動脈狭窄症 (AS) の若い患者で増加しています. しかし,TAVRは外科的な大動脈弁置換 (SAVR) よりも一般的ではありません.
科学分野:
- 心血管医学
- 介入心臓科
- 心臓外科
背景:
- 隔離性大動脈狭窄症 (AS) の若い患者 (65歳未満) で,トランスキャテータ大動脈弁置換 (TAVR) と外科的大動脈弁置換 (SAVR) の使用はほぼ均等である.
- メカニカルSAVRおよび併用手順を含む全スペクトルの大動脈弁置換 (AVR) 処置におけるTAVRの採用傾向は不明である.
研究 の 目的:
- TAVRとSAVRの利用傾向を,重症ASのAVRを65歳未満の患者で調査する.
- TAVR と SAVR (単体および結合) を,処置方法と患者共病性において比較する.
主な方法:
- 2015年から2023年までの多センターレジストリ (北ニューイングランド心血管疾患グループ) の遡及分析.
- 重度のASでAVRを受けた65歳未満の患者1,254人を含む.
- AVRアプローチによる患者の分層: TAVR,単離SAVR,および結合SAVR (併用処置によるSAVR).
主要な成果:
- TAVRの利用率は2倍以上に増加し,バイオプロステスのSAVR率に接近した (2021-2023年の30.8%).
- 機械的なSAVRと組み合わせたSAVRを含めた場合,TAVRは全体のAVR手順の約25%を占めた.
- TAVR患者は,SAVRグループと比較して,より高い併発性負担を示した.
結論:
- TAVRの使用は,ASの若い患者 (65歳未満),特に併発性およびリスクが高い患者で一貫して増加しています.
- TAVRは近年のAS症例の約50%を占めているが,すべてのAVR手順で全体の割合は約25%にとどまっている.
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