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最少侵入性,手术和透导管的大动脉替换:一个网络的元分析

Ahmed K Awad¹, Adham Ahmed², Dave M Mathew²

¹Faculty of Medicine, Ain Shams University, Cairo, Egypt.

Journal of cardiology

|August 23, 2023

概括

与全胸切除术 (FS) 相比,迷你胸切除术 (MS) 手术在主动脉疾病管理方面提供了更好的结果,减少了死亡率,中风和AKI. 过导管大动脉置换 (TAVR) 对AKI有好处,但PVL和PPM的发病率更高.

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
医疗保健服务研究医疗服务研究

背景情况:

过导管大动脉置换 (TAVR) 是外科手术大动脉置换 (SAVR) 的替代方案.
最少侵入性的SAVR方法,包括小胸切除术 (MS) 和小胸切除术 (MT),是传统全胸切除术 (FS) 的新兴替代方案.

研究的目的:

为了比较MS,MT和TAVR与FS的结局,用于大动脉膜疾病的管理.
提供基于证据的不同大动脉干预策略的比较.

主要方法:

一项全面的文献搜索发现了对最小侵入性SAVR (MS/MT) 和TAVR与FS-SAVR的比较研究.
贝叶斯网络元分析 (NMA) 使用随机效应模型进行.
分析了包括30天死亡率,中风,急性损伤 (AKI),严重出血,永久心脏起器 (PPM) 植入和膜漏洞 (PVL) 在内的结果,以及长期死亡率.

主要成果:

与全胸切除术 (FS) 相比,小型胸切除术 (MS) 与30天死亡率,中风,AKI和长期死亡率明显降低.
与FS相比,微型胸腔切除 (MT) 显示30天膜漏水 (PVL) 和重大出血的发生率显著更高.
与FS相比,通过导管的大动脉置换 (TAVR) 显示了明显较低的30天AKI,但与FS相比,PPM和30天PVL的发生率更高.

结论:

与传统的全胸切除术 (FS) 相比,迷你胸切除术 (MS) 在降低死亡率,中风和AKI方面提供了显著的好处.
过导管大动脉置换 (TAVR) 能够预防AKI,但与PVL和PPM植入率的增加有关.
迷你胸切除术 (MT) 与较高的PVL和重大出血率有关.
未来比较TAVR的试验应使用最小侵入性的SAVR方法作为基准,以确保临床平衡.

关键词:

迷你胸骨切除术 (Mini sternotomy) 是一个小型的胸骨切除术.迷你胸部切除术 (Mini Thoracotomy) 是一个小型的胸部切除术.最少的侵入性SAVRR是一种SAVR.这就是SAVR的原因.在TAVRR中,我们可以看到.

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