术前和术后的大动脉替换的趋势在心脏中心结构性大动脉替换时代
Elizabeth L Norton1, Alison F Ward1, Andy Tully1,2
1Division of Cardiothoracic Surgery, Department of Surgery, Emory University, Atlanta, GA, United States.
Frontiers in cardiovascular medicine
|June 7, 2023
概括
过导管大动脉置换 (TAVR) 已经改变了大动脉疾病的管理. 在TAVR后的时代,隔离性外科大动脉置换 (SAVR) 患者的死亡率较低,接收了更大的门,并经历了更少的并发症,显示SAVR仍然至关重要.
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:
- 现在通过导管的大动脉置换 (TAVR) 已被批准用于所有手术风险级别,增加了其使用.
- TAVR的采用导致了手术大动脉置换 (SAVR) 的数量减少.
- 本研究研究了TAVR广泛使用之前和之后的孤立SAVR的趋势.
研究的目的:
- 评估患者特征和孤立SAVR在TAVR前后时期的结果的变化.
- 为了比较两个时代之间在孤立的SAVR中使用特定的门类型和程序技术.
- 在TAVR可用性背景下,评估孤立SAVR的住院结果.
主要方法:
- 在2000年1月至2020年6月期间在一个学术机构进行的3,861个孤立SAVR的分析.
- 患者被分为TAVR前 (2000-2011) 和TAVR后 (2012-2020) 的两个阶段.
- 数据来源于机构的胸部外科医生协会国家数据库.
主要成果:
- 后TAVR组有更多的并发病,更高的再手术和紧急/紧急SAVR,但较低的胸部外科医生协会预测死亡风险 (PROM).
- 在TAVR后的时代,使用了更多的生物假体门,更大的门尺寸和环状扩大.
- 后TAVR组经历了显着较低的输血率,功能衰竭,肺炎和住院死亡率,住院时间更短.
结论:
- 尽管TAVR的增长,孤立SAVR仍然是主动脉病管理的重要程序.
- 在TAVR时代,孤立SAVR在高风险患者身上进行,但结果有所改善,包括死亡率降低.
- 该研究强调了SAVR的持续有效性和安全性,即使TAVR也可用.
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