最少侵入性手术与跨导管大动脉置换:日本的一项回顾性观察性单中心研究
Hiroyuki Yamamoto1, Taisuke Nakayama2, Naoki Ishii3
1Department of Cardiovascular Medicine, Narita-Tomisato Tokushukai Hospital, Japan.
Innovations (Philadelphia, Pa.)
|November 7, 2023
概括
最少侵入性大动脉置换 (MICS-AVR) 是亚洲患者体外透气导管大动脉置换 (TF-TAVR) 的可行替代方案,其存活率相似,但心力衰竭住院和起器植入较少.
科学领域:
- 心血管外科心血管外科
- 干预心脏病学 干预心脏病学
- 医疗技术评估 医疗技术评估
背景情况:
- 大动脉置换是严重的大动脉狭窄的常见手术.
- 最少侵入性大动脉置换 (MICS-AVR) 和输血管穿管大动脉置换 (TF-TAVR) 是传统手术的新兴替代方案.
- 亚洲人群的比较结果数据仍然有限.
研究的目的:
- 在亚洲患者中比较MICS-AVR和TF-TAVR的临床结果.
- 在现实环境中评估这两种大动脉置换技术的安全性和有效性.
主要方法:
- 在日本 (2014-2021) 的回顾性,观察性,单中心研究.
- 包括202个MICS-AVR案件和248个TF-TAVR案件.
- 倾向性得分匹配 (1:1比) 创建了96对匹配对进行分析. 采用了竞争风险回归和调解分析.
主要成果:
- 在所有死因,心脏病死亡,中风或MICS-AVR和TF-TAVR之间的重新干预之间没有显著差异.
- TF-TAVR组的住院时间较长,并有较高的显著膜漏水 (PVL) 发生率.
- MICS-AVR与心力衰竭住院率和永久心脏起器植入率显著降低有关.
结论:
- 在亚洲患者中,MICS-AVR是TF-TAVR的可行和有效替代品.
- MICS-AVR在减少心力衰竭住院和起器需求方面表现出优势.
- 需要更大的随机对照试验来证实这些发现.
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