在外科手术和跨导管生物假肢主动脉中的亚临床传单血栓:一项观察性研究
Tarun Chakravarty1, Lars Søndergaard2, John Friedman1
1Cedars-Sinai Heart Institute, Los Angeles, CA, USA.
Lancet (London, England)
|March 24, 2017
概括
亚临床传单血栓在生物假体主动脉中很常见,特别是在通过导管更换主动脉 (TAVR) 之后. 抗凝药有效治疗这种疾病,降低TIA和中风风险.
科学领域:
- 心脏病学
- 放射学
- 血管外科
背景情况:
- 亚临床传单血栓 (SLT) 是经过透气管大动脉置换 (TAVR) 和手术大动脉置换 (SAVR) 后的已知生物假体大动脉并发症.
- 扫描图像已经使得SLT的检测成为可能,促使对其流行率和治疗进行调查.
研究的目的:
- 确定TAVR和SAVR生物假体大动脉的SLT流行率.
- 评估新型口服抗凝剂 (NOAC) 和其他抗血栓治疗对SLT,膜血液动力学和临床结果的影响.
主要方法:
- 使用RESOLVE和SAVORY两个注册表,注册了2014年至2017年期间接受TAVR或SAVR的患者.
- 用4D体积染方案进行CT成像,在手术后的不同间隔进行.
- 通过CT上减少的叶片运动和低衰减的病变来定义SLT;CT,心声图和神经事件进行了掩面分析.
主要成果:
- 在890个可解释的CT扫描中,106名患者 (12%) 患有SLT,TAVR (13%) 与SAVR (4%) 门的患病率更高 (p=0. 001).
- 与双抗血小板治疗不同,抗凝血疗法 (包括NOAC和华法林) 显著降低了SLT的患病率,并促进了解脱.
- SLT与大动脉梯度的增加和短暂性缺血发作 (TIA) 和中风/ TIA综合事件的更高率有关.
结论:
- 在生物假肢主动脉中,SLT很常见,特别是在TAVR之后,并且可以通过抗凝药有效地治疗.
- 包括NOACs在内的抗凝固疗法在预防和治疗SLT方面表现出有效性,改善了膜血液动力学和临床结果.
- 对SLT预防和治疗的进一步研究有可能提高TAVR的结果.
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