门内透导管大动脉替换与孤立的重复手术大动脉替换
Sarah Yousef1, Derek Serna-Gallegos2, Nidhi Iyanna3
1Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa.
The Journal of thoracic and cardiovascular surgery
|July 3, 2023
概括
门内透管大动脉替换 (ViV TAVR) 和重复手术大动脉替换 (SAVR) 的存活率相似. 与ViV TAVR相比,Redo SAVR的心力衰竭再入院人数较少,但并发症较多.
科学领域:
- 心血管医学 心血管医学
- 干预心脏病学 干预心脏病学
- 心脏外科手术 心脏外科手术
背景情况:
- 大动脉置换是一种常见的手术.
- 重新置换大动脉带有很大的风险.
- 过导管大动脉置换 (TAVR) 是高风险患者的替代方案.
研究的目的:
- 为了比较门内透导管大动脉置换 (ViV TAVR) 与重复手术大动脉置换 (SAVR) 的临床和心声学结果.
主要方法:
- 对TAVR (2013-2022) 和SAVR (2011-2022) 的机构数据库进行回顾性分析.
- 198名ViV TAVR患者与147名再处理隔离的SAVR患者的比较.
- 进行了卡普兰-梅尔生存率,考克斯回归和心力衰竭再入院的竞争风险累积发病率.
主要成果:
- 在这两组中,手术死亡率为2%;在重复SAVR中观察到的预期死亡率高于预期死亡率.
- 改造SAVR患者有更多的输血,出血的重新手术,需要透析的新发功能衰竭和永久的起器需求.
- 在30天和1年后的重复SAVR中,平均梯度较低. 在ViV TAVR中,心力衰竭的再入院率较高.
- 一年生存率相似;ViV TAVR与死亡风险增加无关 (HR1.39,P=.40).
结论:
- ViV TAVR和重复SAVR显示了可比的长期死亡率.
- 翻新SAVR提供更低的术后梯度和更少的心力衰竭再入院,但与更高的并发症率有关.
- 患者的选择应该考虑程序风险和长期结果之间的权衡.
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