大动脉狭窄与冠状动脉疾病:SAVR或TAVR-什么时候以及如何?
Juan Hernando Del Portillo1, Julio Farjat-Pasos1, Attilio Galhardo1
1Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
The Canadian journal of cardiology
|September 27, 2023
概括
对于严重的大动脉狭窄和冠状动脉疾病,通过绕道移植进行外科大动脉置换是复杂病例的最佳选择. 透导管大动脉置换与干预适合高风险患者.
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:
- 增加过导管大动脉置换 (TAVR) 候选人严重的大动脉狭窄 (AS) 也有冠状动脉疾病 (CAD).
- 对于并发性AS和CAD的最佳再血管化策略需要仔细考虑,因为它可能对结果产生影响.
- 同时AS和CAD的患病率因定义和研究人群而异.
研究的目的:
- 确定适合于同时患有严重大动脉狭窄和冠状动脉疾病的患者的再血管化策略.
- 在这个患者群体中,比较不同复血管化方法的结果.
- 确定影响TAVR+PCI和SAVR+CABG之间选择的因素.
主要方法:
- 现有文献的综述,比较了手术性大动脉置换与冠状动脉旁路移植 (SAVR+CABG) 与穿透管大动脉置换与皮肤冠状动脉干预 (TAVR+PCI) 的现有文献.
- 分析包括死亡率,中风和主要心血管事件在内的结果,基于CAD复杂性和手术风险.
- 考虑PCI时间,弹射率和门耐用性等因素.
主要成果:
- SAVR+CABG显示了有利的长期预后.
- TAVR+PCI的结果取决于CAD的复杂性和重血管化的完整性.
- 在低中等风险/CAD患者中,SAVR+CABG和TAVR+PCI之间死亡率或中风没有显著差异.
- 在复杂的CAD患者中,SAVR+CABG可能会提供较低的主要心血管事件.
结论:
- 对于患有复杂CAD的低中等外科风险患者,SAVR+CABG是首选的.
- TAVR+PCI适用于需要完全或合理不完全重血管化的高手术风险患者.
- 需要对替代性CAD评估方法进行进一步的研究,以指导严重AS患者的重血管化.
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