双管大动脉置换与三管大动脉狭窄与死亡率或中风之间的关联
Raj R Makkar1, Sung-Han Yoon1, Martin B Leon2
1Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
JAMA
|June 12, 2019
概括
在双主动脉狭窄症患者中,通过导管进行主动脉置换 (TAVR) 的死亡率与三主动脉狭窄症相似,但中风的风险更高. 需要进一步的随机试验来证实双主动脉狭窄的这些发现.
科学领域:
- 心血管医学
- 干预心脏病学
- 生物医学工程
背景情况:
- 透气导管大动脉置换 (TAVR) 的适用范围正在扩大.
- 越来越多的双主动脉狭窄患者正在接受TAVR治疗.
- 关键的TAVR试验排除了双主动脉解剖的患者.
研究的目的:
- 用气球可扩展对比TAVR的结果在双管与三管主动脉狭窄的患者中.
- 在双主动脉狭窄患者群体中评估TAVR的安全性和有效性.
主要方法:
- 一个基于注册的前性队列研究.
- 来自STS/ACC跨导管疗法注册表的2691名两和三大动脉狭窄患者的倾向性得分对应分析 (2015年6月至2018年11月).
- 主要结局包括30天和1年死亡率和中风.
主要成果:
- 双主动脉狭窄组与三主动脉狭窄组之间30天或1年全因死亡率没有显著差异.
- 在双主动脉狭窄组 (30天) 中,中风发生率显著增加 (2.5%与1.6%相比).
- 在双手术组中,需要开放心脏手术的手术并发症风险更高 (0. 9% vs 0. 4%).
结论:
- 与三主动脉狭窄相比,双主动脉狭窄的TAVR与类似的死亡率相关,但增加了中风风险.
- 没有观察到膜血液动力学或膜泄漏的显著差异.
- 由于潜在的选择偏差,需要进行随机试验,以充分评估TAVR在双主动脉狭窄的疗效和安全性.
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