通过导管或通过手术替换大动脉门的严重大动脉狭窄和小大动脉门患者:随机临床试验
Josep Rodés-Cabau1, Henrique Barbosa Ribeiro2, Siamak Mohammadi1
1Cardiology Department, Quebec Heart & Lung Institute, Laval University, Quebec City, Canada (J.R.-C., S.M., J.-M.P., E.D., D.K., C.G., M.A., E.P.-B., P.P.).
Circulation
|October 26, 2023
概括
在患有严重的大动脉狭窄和小大动脉环形的患者中,透过导管的大动脉置换 (TAVR) 和手术大动脉置换 (SAVR) 显示出相似的血液动力学和临床结果. 治疗选择应该是个性化的,因为TAVR和SAVR都没有表现出优势.
科学领域:
- 心脏病学
- 干预心脏病学
- 心脏外科
背景情况:
- 严重的大动脉狭窄与小的大动脉环 (SAA) 呈现独特的治疗挑战.
- 在SAA患者中,最优的治疗策略比较过导管主动脉置换 (TAVR) 和手术主动脉置换 (SAVR) 尚未明确.
研究的目的:
- 在患有严重大动脉狭窄和SAA的患者中比较TAVR和SAVR的血液动力学和临床结果.
主要方法:
- 一项前性国际随机试验,涉及151名SAA患者 (平均直径<23毫米),随机分为TAVR或SAVR.
- 主要结局:60天后膜血动力学受损 (假肢与患者不匹配或主动脉吐).
- 二次结局:死亡率,中风和心脏病住院,评估时间均为2年.
主要成果:
- 在60天后,在严重的假肢患者不匹配或中度至严重的主动脉吐方面,没有观察到TAVR和SAVR组之间的显著差异.
- 短期 (30天) 和长期 (2年) 结局,包括死亡率,中风和心脏住院,在TAVR和SAVR组之间是可比的.
- 研究群体主要由低至中等手术风险的女性 (93%) 组成.
结论:
- 当代TAVR和SAVR在严重的大动脉狭窄和SAA患者中显示出可比的膜血液动力性能和临床结果.
- 对SAA患者的治疗决定应根据患者的特征和偏好进行个性化.
- 由于当前研究的样本规模和功率有限,需要进行更大规模的研究来证实这些发现.
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