带有机械 mitra 门假体的患者的左心室尾关闭:一个多中心的意大利试点研究
Alberto Preda1, Davide Margonato2, Carlo Gaspardone3
1Electrophysiology Unit, Cardio-Thoraco-Vascular Department, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy.
The Canadian journal of cardiology
|March 16, 2024
概括
左心房尾关闭 (LAAC) 为心房 (AF) 患者提供了一个有前途的替代方案,这些患者有机械假肢门 (PMV),他们经历了维生素K对抗剂 (VKA) 治疗失败. 该程序在高风险患者中证明了安全性和有效性.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 血栓形成的管理
背景情况:
- 接受维生素K抗剂 (VKA) 治疗的心房患者面临显著的心脏血栓栓塞的风险,特别是那些有机械假肢膜 (PMV) 的患者.
- 由于VKA治疗失败,需要在这个高风险AF亚组中采取替代策略来预防血栓栓塞.
研究的目的:
- 评估左心房附属物关闭 (LAAC) 的长期安全性和有效性,在机械PMV经历VKA失败的AF患者中.
- 评估LAAC作为一种替代治疗机械PMV的AF患者血栓栓塞事件的治疗方法.
主要方法:
- 追溯性,多中心研究,招募了机械PMV的AF患者,尽管接受VKA治疗,但由于血栓事件而接受LAAC.
- 机械PMV患者与非膜AF患者之间的比较.
- 主要终点:综合所有死因,主要心血管事件和主要出血;次要终点:LAAC的可行性和安全性.
主要成果:
- 在55名注册患者中,有12名患有机械PMV;71%的LAAC指示是LAA血栓或污泥.
- 程序的成功率是96%的总体和100%在机械PMV组.
- 在平均6.1年的随访期间,4名PMV患者和20名非PMV患者发生了不良事件 (HR 0.73;P=0.564).
结论:
- 在VKA治疗失败时,左心房尾关闭 (LAAC) 似乎是机械PMV的AF患者的可行的替代方案.
- 在现实实践中,LAAC的非标签性使用需要在更大的研究中进行进一步的调查和验证.
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