大动脉根置换后的跨导管内干预:系统性审查
Massimo Baudo1,2, Besart Cuko3, Julien Ternacle3
1Department of Cardiac Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania, USA.
概括
过导管内 (ViV-TAVI) 是大动脉根置换 (ARR) 后结构恶化的可行选择. 仔细考虑患者特异性因素和手术史对于成功的结果至关重要.
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
- 人造心脏门是一种假心脏门.
背景情况:
- 结构膜恶化是主动脉根置换 (ARR) 后的一个已知的并发症.
- 过导管内 (ViV-TAVI) 干预为这些患者提供了潜在的治疗选择.
- 在ARR之后,ViV-TAVI的结果和技术挑战需要进一步阐明.
研究的目的:
- 系统地审查和分析ViV-TAVI手术的结果,这些手术是在先前移植大动脉根的患者中进行的.
- 在这个特定的患者群体中确定与ViV-TAVI相关的技术挑战和成功率.
主要方法:
- 在主要数据库 (PubMed,ScienceDirect,SciELO,DOAJ,Cochrane Library) 进行了全面的文献搜索,截至2023年9月.
- 包括报告在有大动脉根置换病史的患者中进行过任何跨导管干预的研究.
- 分析了31篇文章中的86名患者的数据.
主要成果:
- 从ARR到重新干预的平均时间为11.0年,同种移植是最常见的ARR类型 (67.4%).
- 大动脉反是干预的主要指示 (69.7%).
- 手术后并发症不常见,包括永久心脏起器植入 (7.0%),设备迁移 (3.5%) 和中风 (1.2%). 一小部分 (4.7%) 需要第二次ViV-TAVI.
结论:
- 尽管存在独特的技术挑战,但ViV-TAVI对于一些患有恶化大动脉根置换的患者来说是一个可行的选择.
- 程序前评估,包括计算机断层扫描,对于应对这些挑战至关重要.
- 患有先前ARR的患者往往有很高的外科风险,这使得像ViV-TAVI这样的最小侵入性选择具有吸引力.
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