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跨形大动脉植入:分析299名患者的风险因素和学习经验

Jörg Kempfert¹, Ardawan Rastan, David Holzhey

¹Department of Cardiac Surgery, University of Leipzig, Leipzig, Germany.

|September 14, 2011

概括

经管上大动脉植入的结果随着经验的增加而显著改善,显示死亡率和手术强度降低. 这突出了学习曲线和需要新的风险分数,具体用于这个程序.

科学领域:

心血管外科心血管外科
干预心脏病学干预心脏病学
医疗器械技术医疗器械技术

背景情况:

跨吸管大动脉植入 (TAVI) 是高风险患者的关键治疗方法.
评估学习经验和风险因素对于TAVI优化至关重要.

研究的目的:

在四年时间内评估跨形大动脉植入的学习曲线和与结果相关的风险因素.
分析经验对患者结果和程序效率的影响.

主要方法:

在2006-2010年期间,对299名患者进行了Edwards SAPIEN假肢TAVI的分析.
早期经验 (EE; n=150) 与最近经验 (RE; n=149) 的比较.
多变量后勤回归以确定30天死亡率的独立预测因素.

主要成果:

与EE相比,RE组的物流EuroSCORE得分较高,但STS得分较低.
在RE组中减少了对比染料的使用和气球再稀释.
30天死亡率从11.3% (EE) 降至6.0% (RE),一年死亡率从30.7%提高到21.5%.

结论:

随着经验的增加,TAVI的结果会有所改善,这表明了显著的学习曲线.
了解最佳的患者选择是改善TAVI结果的关键.
传统的外科手术风险因素无法预测TAVI的结果,因此需要新的手术特异性风险评分.

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