非老年人的大动脉置换:现实,指南和证据之间的差距
Lise Geuens1, Lucas Van Hoof1, Alexander Van De Bruaene2
1Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium.
概括
在非老年成人中,对大动脉置换 (AVR) 的治疗选择有很大差异. 机械门很常见,但患者参与关于AVR策略的决策需要改进,以便共享决策.
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
背景情况:
- 在非老年成人 (18-60岁) 中,大动脉置换 (AVR) 提供了多种治疗选择,包括机械,生物,同移植,罗斯手术和跨导管大动脉置换 (TAVR).
- 了解当前的临床实践和医生对AVR策略的看法,对于优化患者护理至关重要.
研究的目的:
- 调查心脏外科医生和心脏病学家关于非老年成人患者大动脉置换 (AVR) 策略的当代意见和实践.
- 在这个特定的患者群体中,确定选择假体门和AVR手术方法的趋势和变化.
主要方法:
- 一项包含43项项目的在线调查在全球范围内分发给心脏外科医生,心脏病专家和实习生.
- 从33个国家的222名医生收集了回复,其中英国,比利时和北美有很大比例.
主要成果:
- 机械是非老年患者中最常用的AVR替代品,生物的受欢迎程度随着患者年龄的增长而增加.
- 罗斯手术和透气管大动脉置换 (TAVR) 都在不到10%的病例中使用,只有12%的外科医生对罗斯手术有经验.
- 一个值得注意的发现是,在23%的病例中,患者没有参与关于门替代品类型的决策过程.
结论:
- 在非老年患者中,AVR的首选手术治疗方法存在显著的变化.
- 加强心脏病部门之间的合作,以及针对不同AVR技术的以患者为中心的结果的专注教育和研究是必不可少的.
- 促进共享决策需要更好地将患者偏好纳入AVR策略选择过程.
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