用气球可扩展替换小切口跨关节跨导管大动脉,用于透析患者
Satoru Domoto1, Junichi Yamaguchi2, Ken Tsuchiya3
1Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan.
Journal of cardiology
|January 12, 2024
概括
透气管大动脉置换 (TAVR) 的结果在透析患者中是相似的,这些患者接受了最小切口的跨关节 (MITS-TAVR) 和输血 (TF-TAVR) 方法. 这项研究发现,在这个高风险人群中,MITS-TAVR和TF-TAVR之间的生存率和死亡率相似.
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
- 腎臟病學 (nephrology) 是一種醫學.
背景情况:
- 与非透析患者相比,接受过导管大动脉置换 (TAVR) 的透析患者的风险更高,结果更差.
- 在透析患者中,替代TAVR方法的结果是不太了解的,并被认为是高风险的.
研究的目的:
- 在透析患者中,比较最小切口跨关节TAVR (MITS-TAVR) 与输膜TAVR (TF-TAVR) 的结果.
- 评估MITS-TAVR在透析患者群体中的安全性和有效性,透析患者群体通常具有较高的外科风险.
主要方法:
- 一个单一中心的观察性研究包括79名连续透析患者.
- 患者在区域麻醉下接受了MITS-TAVR (n=22) 或TF-TAVR (n=57).
- 结果的比较包括30天死亡率,长期存活率和心血管死亡率.
主要成果:
- 麻省理工学院研究小组的外周动脉疾病,毛的大动脉和形大动脉的发病率明显更高.
- 在MITS-TAVR (4.54%) 和TF-TAVR (1.75%) (p=0.479) 之间,30天死亡率是可比的.
- 在两年生存率 (MITS: 77.3% vs. TF: 68.8%) 或无心血管死亡率 (MITS: 90.9% vs. TF: 96.5%) 中没有发现显著差异.
- 多变量分析证实,MITS和TF组之间生存率没有显著差异 (HR 1.48;p=0.244).
- 在MITS组的随访期间,ipsilateral透析的通透率保持在100%.
结论:
- 在透析患者中,最小切口跨关节TAVR (MITS-TAVR) 的结果与输血关节TAVR (TF-TAVR) 的结果相似.
- 尽管MITS组的患者具有更高风险的特征,但该程序产生了类似的生存率和死亡率.
- 对于透析患者来说,MITS-TAVR是一种可行的替代方案,即使是那些对TF-TAVR有禁忌的人,也具有可接受的安全性和有效性.
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