经过透导管和外科动脉置换之后的冠状动脉再血管化
Davide Gabbieri1, Federico Giorgi2, Greta Mascheroni1
1Cardiac Surgery Unit, Department of Medical-Surgical Cardiology, Hesperia Hospital Modena, 41125 Modena, Italy.
Journal of clinical medicine
|December 9, 2023
概括
通过导管的大动脉植入 (TAVI) 和外科大动脉置换 (SAVR) 显示了类似的中期无冠状动脉再血管化. 这项现实研究发现,在两种手术后,严重大动脉狭窄患者的皮肤冠状动脉干预 (PCI) 发生率较低.
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:
- 之前的跨导管大动脉植入试验 (TAVI) 的随访时间有限,阻碍了对冠状动脉再血管化率的评估.
- 确定TAVI后冠状动脉再血管化的发病率与外科主动脉置换 (SAVR) 之间的差异对于患者管理至关重要.
- 这项研究解决了对TAVI和SAVR在严重大动脉狭窄 (AS) 后冠状动脉复血管化的现实世界中期数据的需求.
研究的目的:
- 研究和比较SAVR和TAVI后冠状动脉复血管化的流行病学,在严重AS患者中进行.
- 分析患有或没有先前存在的冠状动脉疾病 (CAD) 的患者的复血管化率.
- 在现实世界中评估中期结果,单一中心设置.
主要方法:
- 一组1486名AS患者在2010年至2020年期间使用爱德华兹气球可扩展透气管心脏 (THV) 接受了SAVR或TAVI.
- 医院出院记录被用来确定通过皮肤冠状动脉干预 (PCI) 治疗的缺血事件的发生率.
- 专门分析了以前没有CAD的患者的一个子组.
主要成果:
- 五年整体生存率为78.2%.
- 在5年后,SAVR和TAVI组的PCI免费性相同 (96.9%).
- 之前的PCI是后续再血管化的显著预测因素 (HR 4.86,p < 0.001),但两种门置换方法之间的PCI曲线自由度没有显著差异.
结论:
- 即使在老年人群中,TAVI和SAVR后冠状动脉再血管化的发生率也很低 (2.4%),因此需要在年轻人群中进行进一步的研究,随访时间更长.
- 爱德华兹气球可扩展THV的演变并没有影响未来皮肤穿冠状动脉干预 (PCI) 或冠状动脉血管学的可行性.
- 中期结果表明,TAVI和SAVR在冠状动脉复血管化方面具有可比的安全性.
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