在外科手术和跨导管大动脉置换期间对心房的管理
J Hunter Mehaffey1, Mohammad Kawsara2, Vikrant Jagadeesan2
1Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia.
The Annals of thoracic surgery
|April 3, 2024
概括
在医疗保险患者中,通过心房动治疗 (SAVR+AF) 进行大动脉置换手术可以改善存活率并减少中风再入院率,而不是通过导管进行大动脉置换 (TAVR). 在AF患者中,应考虑SAVR+AF作为主动脉置换的第一线治疗.
科学领域:
- 心脏病学 心脏病学
- 心脏外科手术 心脏外科手术
- 医疗保健服务研究 医疗服务研究
背景情况:
- 社会指南建议在手术上更换大动脉门 (SAVR) 期间治疗心房动 (AF).
- 过导管大动脉置换 (TAVR) 越来越多地用于低至中等风险的AF患者.
- 比较这些治疗策略的长度结果至关重要.
研究的目的:
- 评估和比较AF治疗在接受SAVR和TAVR的患者中AF治疗的纵向结果.
- 为了确定SAVR (SAVR+AF) 期间同步AF治疗的有效性,与单独的SAVR和TAVR相比.
主要方法:
- 利用了美国医疗保险和医疗补助服务中心的住院病人的索赔数据库 (2018-2020).
- 包括医疗保险受益者与AF接受TAVR或SAVR与/或没有AF治疗 (例如,左心房附属物消灭,切除).
- 员工两倍强大的风险调整程序比较.
主要成果:
- 与TAVR相比,SAVR+AF显示了更好的生存率 (HR,0.79;P=.019) 和更低的中风再入院率 (HR,0.68;P<.0001).
- 与TAVR相比,SAVR+AF与更高的住院死亡率 (OR,4.02;P<.0001) 有关.
- TAVR与心脏起器需求增加 (OR,3.45) 和血管损伤 (OR,9.09) 有关.
结论:
- 对于接受大动脉置换的AF的医疗保险受益人来说,SAVR+AF提供了优越的纵向存活率和中风预防,而不是TAVR.
- 应考虑SAVR+AF治疗作为AF患者的首要治疗方法,这些患者需要动脉置换.
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