在接受过导管大动脉置换的患者中,结果具有非常低的基线梯度
Faisal Rahman1, Hetal H Mehta2, Jon R Resar1
1Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD, United States.
Frontiers in cardiovascular medicine
|August 21, 2023
概括
过导管大动脉置换 (TAVR) 改善了严重大动脉狭窄 (AS) 患者的健康状况,即使是那些有非常低梯度 (VLG) 患者. 基线并发症,而不是VLG本身,驱动TAVR后的初始结果差异.
科学领域:
- 心脏病学 心脏病学
- 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:
- 严重的大动脉狭窄 (AS) 带来了重大风险.
- 过导管大动脉置换 (TAVR) 是对AS的关键治疗方法.
- 接受TAVR的非常低梯度 (VLG) AS患者的结果需要进一步调查.
研究的目的:
- 为了评估严重AS患者的TAVR结局,根据基线平均大动脉梯度分层分层.
- 为了比较非常低梯度 (VLG),低梯度 (LG) 和高梯度 (HG) 之间的结果,TAVR后的AS组.
主要方法:
- 对1006名患有严重AS的患者进行了回顾性单中心研究,这些患者接受了TAVR.
- 根据平均大动脉梯度将患者分为VLG (≤25 mmHg),LG (26-39 mmHg) 和HG (≥40 mmHg) 组.
- 主要结局:包括堪萨斯城心肌病问卷-12 (KCCQ-12) 评分低 (<45),KCCQ-12显著下降 (≥10) 或1年死亡.
主要成果:
- 与LG (29.9%) 和HG (23.1%) 组相比,VLG组 (82名患者) 的1年初级结局率 (46.7%) 较高 (p=0.002).
- VLG患者呈现出更多的基线并发症.
- 在根据基线特征进行调整后,在两组之间没有观察到结果的显著差异.
- 在TAVR后的30天和1年,VLG患者的KCCQ-12得分显著改善.
结论:
- 虽然接受TAVR的VLGAS患者最初显示出更高的不良事件率,但这主要是由于基线并发症.
- 在严重的AS患者中,TAVR显著改善了他们的健康状况,无论他们的基线平均大动脉梯度如何.
- 在不同的梯度类别中,TAVR是严重AS的有效治疗选择.
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