心脏重置手术或通过导管对心心关节替换对于患有失败的对心关节假肢的患者
Hiroki A Ueyama1, Yoshihisa Miyamoto2, Atsuyuki Watanabe3
1Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA.
Journal of the American College of Cardiology
|October 25, 2023
概括
重复手术中枢替换 (SMVR) 和透导管中枢替换 (TMVR) 显示了对失败的假肢的中期结果相似. TMVR最初的风险较低,但6个月后风险更高,而程序量影响了SMVR的结果.
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
- 心脏外科手术 心脏外科手术
背景情况:
- 有有限的证据可以比较手术重复置换 mitra 门 (SMVR) 和过导管 mitra 门置换 (TMVR) 之间的患者结局,因为 mitra 假肢失败.
- 了解比较疗效对于指导这种不断增长的患者群体的治疗决策至关重要.
研究的目的:
- 为了比较重复SMVR与TMVR的中期结果 (长达3年) 在医疗保险受益者 (≥65岁) 中,有失败的额头骨假肢.
- 评估 SMVR 和 TMVR 的程序案件数量与结果之间的关联.
主要方法:
- 对于65岁以上的医疗保险受益者进行回顾性分析,这些受益者接受了重复SMVR或TMVR,以治疗失败的额头假肢 (2016-2020年).
- 主要终点:中期主要不良心血管事件 (MACE),包括因任何原因的死亡,心力衰竭再住院,中风或重新干预.
- 使用倾向分数匹配分析来比较两组之间的结果.
主要成果:
- 总共有4,293名患者被纳入;64%接受了重复SMVR和36%的TMVR. 接受TMVR的患者年龄较大,并具有较高的并发症负担.
- 在匹配的队列中 (每组n=1317),中期MACE风险相似 (调整HR:0.92;95%CI:0.80-1.04).
- 在头6个月内,TMVR显示MACE风险较低 (调整HR:0.75;95%CI:0.63-0.88),但在6个月后风险较高 (调整HR:1.28;95%CI:1.04-1.58). 增加重复SMVR体积与MACE风险降低相关,与TMVR不同.
结论:
- 对于失败的额头骨假肢,3年后重复SMVR和TMVR的结果相似,TMVR最初具有优势,但后来具有劣势.
- 在重复SMVR和TMVR之间做出选择应该平衡手术风险,患者寿命和机构专业知识.
- 程序量是重复SMVR后影响结果的重要因素,强调了经验丰富的中心的重要性.
相关概念视频
Mitral Stenosis III: Medical Management
12
Mitral stenosis, a condition marked by the narrowing of the mitral valve, necessitates an integrated approach for effective management. This approach includes preventative measures, medical therapy, and surgical interventions to reduce symptoms and prevent complications.PreventionPrevention of mitral stenosis primarily focuses on reducing the incidence of bacterial infections, particularly streptococcal infections, which can lead to rheumatic fever and subsequent valvular damage. Timely...
12
Mitral Regurgitation III: Medical Management
18
Mitral regurgitation (MR) is characterized by retrograde blood circulation from the left ventricle into the left atrium due to inadequate mitral valve closure. The severity of the condition, symptoms, and underlying cause determine treatment strategies.Monitoring and Pharmacological TreatmentPatients with mild to moderate MR typically do not need immediate intervention but regular monitoring to assess progression and guide treatment. Patients with mild MR should have an echocardiogram every 3-5...
18
Mitral Valve Prolapse II: Assessment and Management
19
IntroductionA range of clinical features characterizes Mitral Valve Prolapse (MVP), but it is important to note that many individuals with MVP are asymptomatic and may remain so throughout their lives. For those who do exhibit symptoms, the following are the key clinical features:Palpitations: This is a common symptom where individuals feel an irregular or rapid heartbeat. Palpitations in MVP are often due to arrhythmias such as premature ventricular contractions or supraventricular...
19
Mitral Regurgitation IV: Nursing Management
40
Mitral regurgitation (MR) is a condition where the mitral valve does not close properly, leading to the backward flow of blood from the left ventricle into the left atrium during systole. This condition can arise from various causes, including rheumatic fever, infective endocarditis, or degenerative valve disease. Effective nursing management is crucial to optimizing patient outcomes and involves comprehensive assessment and targeted interventions.Comprehensive Patient AssessmentA detailed...
40
Mitral Stenosis IV: Nursing Management
13
A comprehensive nursing assessment is essential for patients with valvular heart disease, which involves any dysfunction of the heart valves that could impact blood flow and overall heart function.Subjective Data Collection:Chief Complaint and Present Illness: Start with the patient's primary concerns, focusing on the onset, duration, and progression of cardiac symptoms such as dyspnea, fatigue, chest pain, and palpitations.Past Medical History: Collect detailed information on any previous...
13
Mitral Regurgitation I: Introduction
15
Mitral regurgitation is characterized by the backward circulation of blood from the left ventricle to the left atrium during systole, a phase of the cardiac cycle when the heart contracts and pumps blood out of the chambers. This abnormal flow occurs primarily due to the dysfunction of the mitral valve or its supporting structures, which include the mitral leaflets, chordae tendineae, annulus, and papillary muscles.Etiology and Mechanisms:Primary Mitral Regurgitation: This type arises from...
15


