跨导管大动脉置换失败后的重置大动脉再干预中的挑战和未来方向
Syed Zaid1, Vinayak N Bapat2, Janarthanan Sathananthan3
1Division of Cardiology, Baylor College of Medicine, Michael E. DeBakey VA Medical Center, Houston, TX (S.Z.).
Circulation. Cardiovascular interventions
|November 21, 2023
概括
由于跨导管大动脉置换 (TAVR) 在年轻患者中使用,TAVR衰竭的重新干预将增加. 本综述考察了重复TAVR和外科探索,详细介绍了大动脉狭窄管理的挑战和未来方向.
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
- 生物医学工程 生物医学工程
背景情况:
- 通过导管的大动脉置换 (TAVR) 越来越多地用于年轻,风险较低的患者.
- 生物假体门的耐用性需要在未来对TAVR故障进行重新干预.
- 大动脉狭窄的终身管理需要了解重新干预的选择.
研究的目的:
- 审查当前有关心脏门故障的回复TAVR和TAVR解释的证据.
- 识别主动脉再干预的挑战和未来方向.
- 为指导在TAVR后需要重新干预的患者的临床决策.
主要方法:
- 对 redo-TAVR 和 TAVR 解释研究的文献综述.
- 对每个重新干预策略相关的结果,可行性和风险的分析.
- 综合当前数据,为未来的研究和临床实践提供信息.
主要成果:
- 重复TAVR是一种侵入性较小的替代方案,但可能受到冠状动脉进入和阻塞风险的限制.
- 对于手术候选人来说,TAVR扩张是可行的,但与高死亡率和发病率有关.
- 这两种策略都带来了不同的挑战,需要仔细选择患者.
结论:
- 对TAVR衰竭的再干预是一个新兴的临床挑战.
- 在 redo-TAVR 和 TAVR 探索之间做出选择取决于患者特定的因素和程序风险.
- 需要进一步的研究,以优化跨导管心脏膜再干预的结果.
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