跨导管大动脉置换患者的结果 具有不同的跨膜流量梯度模式的患者
Manuela Muratori1, Laura Fusini2, Gloria Tamborini1
1Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy.
The American journal of cardiology
|October 20, 2023
概括
过导管大动脉置换 (TAVR) 对低流量低梯度大动脉狭窄 (LF-LG AS) 有效. 然而,与正常流量高梯度AS相比,经典LF-LGAS患者在TAVR后5年面临死亡风险翻倍的风险.
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:
- 低流量低梯度 (LF-LG) 大动脉狭窄症 (AS) 带来管理挑战,预后不佳,特别是与经过透气管大动脉置换 (TAVR) 后的正常流量高梯度 (NF-HG) AS相比.
- 对于接受TAVR的LF-LGAS患者的结果,现有的数据有限且有争议.
- 了解AS中的不同血液动力学模式对于患者管理和风险分层至关重要.
研究的目的:
- 在严重的大动脉狭窄症中表征明显的跨膜流量梯度模式.
- 为了评估这些模式的预后价值通过导管大动脉替换后.
- 为了比较正常流量高梯度 (NF-HG),矛盾的LF-LG (pLF-LG) 和经典的LF-LG (cLF-LG) 之间的结果,TAVR后的AS患者.
主要方法:
- 分析了一组1208名患有严重AS且接受TAVR的患者.
- 患者被分为NF-HG (n=976),pLF-LG (n=107) 和cLF-LG (n=125) 基于平均大动脉压力梯度,左心室喷射率和中风体积指数.
- 临床结果,包括30天死亡率和5年生存率,在各组进行了比较.
主要成果:
- 与NF-HG和PLF-LG组相比,古典LF-LG患者表现出更糟糕的症状状态和更高的左心室后负荷.
- 虽然30天死亡率没有显著差异,但与PLF-LG (62%) 和NF-HG (68%) 相比,cLF-LG患者的5年生存率明显较低 (50%).
- 经典的LF-LG独立地与TAVR后5年死亡风险增加2.41倍有关.
结论:
- 超导管大动脉替换在所有流量梯度模式中表现出优异的短期和长期膜功能.
- 矛盾的LF-LGAS患者在TAVR后显示出与NF-HGAS患者相似的生存率.
- 经典的LF-LG AS代表了TAVR后的高风险亚组,需要仔细的血液动力学表征和潜在的专业管理策略.
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