大动脉置换的利用和结果 (来自美国再接收数据库)
Shashank Shekhar1, Abhishek Ajay1, Toshiaki Isogai1
1Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
概括
大动脉置换 (AVR) 在患有大动脉狭窄 (AS) 和大动脉吐 (AR) 的心力衰竭患者中未得到充分利用. 大多数患者没有接受AVR,尽管结果更差,这表明需要进一步研究.
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
- 医疗保健服务研究 医疗服务研究
背景情况:
- 同时发生大动脉狭窄 (AS) 和/或大动脉吐 (AR) 的心力衰竭患者代表了重大的临床挑战.
- 在这个人群中,最佳的管理策略,包括使用大动脉置换 (AVR),尚未明确定义.
研究的目的:
- 评估心力衰竭和AS (CHF+AS) 或AS与AR (CHF+AS+AR) 的患者中跨导管大动脉植入 (TAVI) 和外科大动脉置换 (SAVR) 与无AVR的利用模式.
主要方法:
- 全国再接收数据库 (2016-2018) 的回顾性分析.
- 包括患有CHF+AS和CHF+AS+AR队列的患者.
- 对AVR利用率 (TAVI,SAVR,无AVR) 和短期结果进行比较.
主要成果:
- 大多数CHF+AS患者 (79.9%) 和CHF+AS+AR患者 (53.2%) 没有接受AVR.
- 在最初没有AVR治疗的患者中,仅有一小部分患者 (CHF+AS的7.9%,CHF+AS+AR的11.8%) 在随后的六个月内接受AVR治疗.
- 与接受AVR治疗的患者相比,没有AVR治疗的患者的短期结果较差.
结论:
- 大动脉置换 (AVR) 在心力衰竭患者中未得到充分利用,这些患者同时患有AS和/或AR.
- 需要进一步的研究,以阐明最佳时间,适应症和AVR在这个患者群体中的利用.
- 目前的管理模式表明,在护理方面存在潜在的差距,非干预与较差的短期结果有关.
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