通过导管对心肌膜更换后的心肌损伤与手术重新手术相比
Mauricio Felippi de Sá Marchi1, Vitor Emer Egypto Rosa2, Pedro Felipe Gomes Nicz2
1Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil; Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands.
The American journal of cardiology
|December 17, 2023
概括
心肌损伤在关修复后很常见,手术重新手术导致生物标志物增加高于透气管手术. 心脏生物标志物升高预测这些患者的长期死亡率.
科学领域:
- 心脏病学 心脏病学
- 心血管外科心血管外科
- 干预心脏病学 干预心脏病学
背景情况:
- 额头膜生殖假体功能障碍需要干预,可以选择通过导管的额头膜替换 (TMVR) 和手术的额头膜替换重新操作 (SMVR-REDO).
- 在干预后评估心肌损伤及其临床影响对于患者的治疗结果至关重要.
研究的目的:
- 为了比较TMVR和SMVR-REDO之间心肌损伤的发病率和临床影响,心脏生物标志物升高表明.
- 为了确定这些程序后的死亡率预测因素.
主要方法:
- 一项队列研究包括从2014年至2023年期间310名患有 mitrale 生物假体失败 (90个TMVR,220个SMVR-REDO) 的患者.
- 心脏生物标志物 (CK-MB,cTn) 在干预后连续测量.
- 多变量分析和倾向性得分匹配,调整为基线差异;根据MVARC标准评估结果.
主要成果:
- 几乎所有患者都经历了干预后生物标志物增加 (100% SMVR-REDO vs. 94% TMVR),在6-12小时达到峰值.
- 与TMVR相比,SMVR-REDO显示心脏生物标志物的增加是TMVR的2-3倍.
- 三十天死亡率为16.8% (SMVR-REDO) 与13.3% (TMVR);在19个月,它是17.7% (SMVR-REDO) 与21.1% (TMVR).
结论:
- 肌肉心脏损伤是伴随着关节生物修饰退行治疗的全身性事件,特别是在SMVR之后.
- 升高的CK-MB和cTn水平与累积晚期死亡率的增加有关,无论治疗方法如何.
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