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在患有心房的患者中同时进行左心房塞和透导动脉置换

Samir R Kapadia¹, Amar Krishnaswamy¹, Brian Whisenant²

¹Cleveland Clinic, Cleveland, OH (S.R.K., A.K., V.M., K.W., Q.W.).

|October 24, 2023

概括

在心房动患者中,同时进行左心房塞 (LAAO) 和跨导管主动脉置换 (TAVR) 是医疗治疗的安全替代方案. 这种联合治疗方法在两年内在预防中风和出血方面表现出非劣势.

科学领域:

心脏病学
干预心脏病学
医疗器械

背景情况:

在接受过导管大动脉置换 (TAVR) 的患者中,心房动 (AF) 很常见.
在TAVR患者中增加了中风和出血的风险.
左心房塞 (LAAO) 是预防中风的抗凝药的替代方案,但其在TAVR期间的使用尚未得到充分研究.

研究的目的:

评估TAVR与LAAO (WATCHMAN装置) 联合治疗的安全性和有效性与TAVR与AF患者的药物治疗.
为了比较2年内全因死亡率,中风和严重出血的主要终点.

主要方法:

这是一项多中心随机试验,将TAVR + LAAO与TAVR + 药物治疗进行比较.
包括349名患有严重的大动脉狭窄和AF的患者.
主要终点是2年内全因死亡率,中风和严重出血的综合结果.

主要成果:

对于主要终点,TAVR+LAAO组与TAVR+药物治疗组相比没有劣势 (22. 7对27. 3每100个患者年;HR为0. 86).
随着对比度的增加,LAAO的增量过程时间为38分钟.
在24个月后,LAAO组中接受抗凝药的患者较少 (13. 9% vs 66. 7%).

结论:

同时使用LAAO和TAVR,对于AF重症大动脉狭窄患者的中风和出血风险,其效果与TAVR无差.
应考虑 LAAO 和 TAVR 联合的程序复杂性和风险.
在接受TAVR的特定AF患者中,LAAO可能提供长期抗凝药的替代方案.

关键词:

大动脉狭窄症心房动临床试验作为主题通过导管更换大动脉

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