跨关节与跨关节的跨管大动脉置换:一个系统的审查和元分析
Cyrus Munguti1, Paul Ndunda1, Mohinder R Vindhyal1
1Internal Medicine, University of Kansas School of Medicine - Wichita, KS, United States of America.
概括
相比于跨胸膜TAVR,跨胸膜跨导管大动脉置换 (TC-TAVR) 显示30天的MACE和出血减少. 在这两种方法中,死亡率,中风和膜吐的结果是相似的.
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
- 手术创新 在外科创新.
背景情况:
- 对于某些患者,TAVR的胸外治疗方法可能不适合,或导致更糟糕的结果.
- 对TAVR的替代通道正在获得引力.
- 超状管甲状腺替换术 (TC-TAVR) 是这样一种替代途径.
研究的目的:
- 系统地审查TC-TAVR的文献.
- 进行一项元分析,将TC-TAVR结果与其他TAVR访问路线进行比较.
- 评估TC-TAVR的安全性和有效性.
主要方法:
- 在4个在线数据库中对受控随机和非随机研究进行了全面的搜索.
- 包括16项TC-TAVR.观察性研究.
- 用95%置信区间和希金斯I2用于异质性的风险比率进行元分析.
主要成果:
- 与跨胸部TAVR (TT-TAVR) 患者 (n=524) 相比,TC-TAVR患者 (n=180) 的30天MACE (7.8%对13.7%) 和重大/危及生命的出血 (4.0%对14.2%) 较低.
- 在30天死亡率,中风/TIA或中度/严重的大动脉吐方面没有观察到显著差异.
- 在TC-TAVR组 (3.0%对7.8%) 观察到较少主要血管并发症的趋势.
结论:
- 与跨胸部TAVR相比,TC-TAVR与30天MACE和危及生命的出血减少有关.
- TC-TAVR显示了可比的30天死亡率,中风/TIA率,以及大动脉回吐率与 transthoracic TAVR.
- TC-TAVR代表了一种可行的替代性通道,用于跨导管大动脉更换.
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