索引大动脉替换后重新干预对后续死亡风险的影响
William Y Shi1, Alexandra Malarczyk2, Ryan A Watson3
1Department of Cardiovascular Surgery, Northwell Health, New York, NY.
JTCVS open
|January 11, 2024
概括
在生物假体门置换后,大动脉门的重新干预增加了死亡风险,特别是在年轻的患者中. 对重复手术AVR和门内TAVR的生存率相似.
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
- 生物材料科学 生物材料科学
背景情况:
- 生物假体大动脉置换 (AVR) 携带结构性退化的风险 (SVD).
- 在SVD需要主动脉 (AV) 重新干预时,要么重复手术AVR (SAVR) 或内TAVR (ViV-TAVR).
- 在索引SAVR和随后的再干预后的长期存活需要评估.
研究的目的:
- 评估AV再干预 (re-SAVR或ViV-TAVR) 在初始SAVR后对长期存活的影响.
- 在需要重新干预的患者中,比较重新SAVR与ViV-TAVR的结果.
- 为了确定与AV再干预相关的差异性风险的患者子组.
主要方法:
- 对4167名接受索引生物假体SAVR (2002-2017) 的患者进行了回顾性分析.
- 考克斯回归分析与AV再干预 (re-SAVR,ViV-TAVR) 作为时间变化的共变量.
- 纵向随访评估后续死亡风险.
主要成果:
- 在3.3%的患者中需要重新进行AV干预 (139/4167).
- 重复干预与随后死亡风险增加2.53倍相关 (P < .001).
- 这种增加的风险在65岁以下的患者 (HR 5.60) 与65岁以上的患者 (HR 2.06) 相比显著更高.
- 在重复SAVR (74%) 和ViV-TAVR (80%) 组之间,五年生存率是可比的 (P = .67).
结论:
- 在生物假肢AVR之后,对SVD进行AV再干预增加了随后的死亡风险.
- 年轻的患者 (65岁以下) 在重新干预后经历了更明显的生存劣势.
- 对于AVR指数的治疗决定,应考虑终身管理和患者对潜在的未来重新干预的偏好.
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