在跨导管大动脉更换后,所有原因的程序性再入院
Paige Newell1, Hoda Javadikasgari1, Mehida Rojas-Alexandre1
1Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
JTCVS open
|October 9, 2023
概括
过导管大动脉置换 (TAVR) 后的后续手术再入院是常见的,但不会影响患者的存活率. 这些干预措施,无论是心脏还是非心脏,在必要时可以在TAVR之后安全地进行.
科学领域:
- 心血管医学 心血管医学
- 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:
- 超导管大动脉置换 (TAVR) 资格正在扩大到预期寿命更长的患者.
- 在TAVR之后的后续程序越来越常见,需要评估.
研究的目的:
- 调查TAVR后接受程序性再入院的患者的发病率和结果.
- 确定这些再入院是否会影响长期存活率.
主要方法:
- 从2012年至2019年接受TAVR的1092名患者的回顾性分析.
- 对持续超过1天的手术的死亡率和再入院的评估.
- 使用考克斯比例危险模型和竞争性风险分析进行生存分析.
主要成果:
- 20%的患者在34个月的中位随访期间经历了244次程序性再入院 (260次程序).
- 心脏手术包括心脏起器植入和PCI;非心脏包括骨科和胃肠道干预.
- 在手术风险组 (HR 1.25,P = .17) 中,程序性再入院与生存处罚无关.
结论:
- 在TAVR后的程序性干预是常见的,通常发生在第一年内.
- 随后的程序性再接收似乎不会给生存带来不利影响.
- 在TAVR后,应采取必要的程序,以满足患者的需求.
相关概念视频
Aortic Regurgitation III: Medical Management
24
Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
24
Aortic Regurgitation II: Clinical Features and Diagnostic Tests
23
Aortic valve regurgitation (AR) occurs when the aortic valve fails to close properly, allowing blood to flow backward from the aorta into the left ventricle. This backflow can result in two distinct clinical presentations: acute and chronic AR, each characterized by its own set of symptoms and physical findings.Acute Aortic RegurgitationAcute AR presents with a sudden onset of severe symptoms. Patients typically experience profound dyspnea (shortness of breath), chest pain, and signs of left...
23
Aneurysm III: Interprofessional Care
9
Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
9
Cardiac Catheterization II: Right Heart Catheterization
34
Right Heart Catheterization: An OverviewRight heart catheterization is an invasive diagnostic procedure that measures right-sided cardiac and pulmonary artery pressures, calculates cardiac output, and identifies intracardiac shunts. It provides detailed hemodynamic data essential for diagnosing and managing various cardiovascular conditions, such as pulmonary hypertension.Access SitesCommon access sites for right heart catheterization include the internal jugular vein in the neck region, the...
34
Cardiac Catheterization I: Pre-Procedure Overview
38
Cardiac catheterization is an invasive diagnostic technique used to identify and evaluate structural and functional diseases of the heart and major blood vessels. This technique diagnoses congenital heart disease, coronary artery disease, valvular heart disease, and coronary spasms and assesses ventricular function. It helps guide treatment decisions, including the need for revascularization procedures like percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) and...
38
Aortic Regurgitation I: Introduction
10
IntroductionAortic regurgitation is characterized by the backward flow of blood from the aorta into the left ventricle during diastole and arises from the improper closure of the aortic valve. This condition results in left ventricular volume overload and can stem from both acute and chronic etiologies, each contributing uniquely to the disease's progression and symptomatology.Acute and Chronic CausesAcute aortic regurgitation often results from events that suddenly impair the integrity of the...
10


