超导管大动脉替换纯原生大动脉反:万象馆国际项目
Enrico Poletti1, Ole De Backer2, Andrea Scotti3
1Clinical and Interventional Cardiology Department, IRCCS Policlinico San Donato, Milan, Italy.
JACC. Cardiovascular interventions
|August 30, 2023
概括
对于严重的本源性大动脉反 (NAVR) 的跨导管大动脉置换 (TAVR) 仍然具有挑战性,跨导管大动脉栓塞或迁移 (TVEM) 构成重大风险. 新一代设备在自扩展平台和气球可扩展平台之间显示了可比的性能.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 医疗器械 医疗器械
背景情况:
- 过导管大动脉置换 (TAVR) 对于纯严重的本源大动脉反 (NAVR) 在历史上产生了低于最佳的结果.
- 以前的证据主要利用了较旧的跨导管心脏门 (THV) 代,需要更新研究.
研究的目的:
- 评估当代THV在接受TAVR治疗纯严重NAVR的患者中的疗效和安全性.
- 为了比较自扩展 (SE) 和气球可扩展 (BE) THV平台在这个特定患者队列中的性能.
主要方法:
- 在PANTHEON研究中,追溯分析了201名患有严重NAVR的患者,这些患者接受了当前SE或BE TAVR设备的治疗.
- 关键的终点包括技术和设备的成功率,以及所有原因的死亡率和一年内心力衰竭再入院的复合值.
- 特别评估了急性透管栓塞或迁移 (TVEM) 的发生率和临床影响.
主要成果:
- 总体而言,技术和设备的成功率分别为83.6%和76.1%,SE和BE设备之间没有显著差异.
- 过导管栓塞或迁移 (TVEM) 发生在14.6%的患者中,大大促进了次优的成功率.
- 与没有TVEM的患者相比,经历TVEM的患者在一年内复合终点 (死亡率/心力衰竭再住院) 的发病率更高 (25.7%vs15.8%).
结论:
- 尽管THV技术和TAVR技术的进步,纯粹的严重NAVR仍然是一个复杂的迹象.
- 过导管栓塞或迁移 (TVEM) 是一种关键并发症,在这种情况下与较差的临床结果有关.
- 自扩展和气球可扩展THV平台在治疗严重的NAVR方面表现相似.
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