在TAVR和SAVR后的假体内心炎:PARTNER试验的见解
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
概括
通过导管或外科动脉置换后的假心内膜炎 (PVE) 是罕见的,但会显著增加死亡率. 在TAVR和SAVR之间,发病率,风险因素和发病时间相似,这凸显了警的必要性.
科学领域:
- 心血管医学
- 传染性疾病
- 医疗设备技术
背景情况:
- 假内心炎 (PVE) 是主动脉置换 (AVR) 后的一个关键并发症,影响过导管 (TAVR) 和外科手术 (SAVR).
- 鉴于TAVR在不同患者群体中的使用越来越多,了解PVE的发病率,风险因素和结果至关重要.
研究的目的:
- 在接受TAVR或SAVR的患者中描述PVE的发病率,危险因素,微生物特征和结局.
- 将TAVR和SAVR方法之间的PVE率和特征进行比较.
主要方法:
- 来自PARTNER试验和注册表的合并队列的分析,包括用TAVR或SAVR治疗的重症大动脉狭窄患者.
- 使用修改的杜克标准进行PVE判定,分析发病率,时间,致病生物和所有原因死亡率.
主要成果:
- 在8530名患者中,PVE发生在1. 3% (每1000人年发生5. 06) 患者中,TAVR和SAVR的发病率相似.
- 基线肝硬化,肺部疾病和功能衰竭与PVE风险增加有关.
- 在SAVR后,PVE与全因死亡率有很强的联系 (HR,4. 4),而葡萄球菌更为常见.
结论:
- 在现代AVR之后,PVE仍然是一种罕见但往往致命的并发症,TAVR和SAVR之间发生率或预测因子没有显著差异.
- 这些发现强调了所有AVR患者的PVE监测的重要性,无论手术类型如何.
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