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跨导管大动脉置换后的心脏手术:趋势和结果

Michael E Bowdish¹, Robert H Habib², Tsuyoshi Kaneko³

¹Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.

The Annals of thoracic surgery

|April 5, 2024

概括

过导管大动脉置换 (TAVR) 后的心脏手术正在增加,风险高于预期,结果更差. 这些发现需要仔细考虑TAVR在年轻,低风险患者由于有限的长期数据.

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
医疗保健服务研究医疗服务研究

背景情况:

经过过导管大动脉置换 (TAVR) 和早期TAVR扩张后的心脏手术的报告正在增加.
这种趋势需要了解相关的风险和结果.

研究的目的:

记录TAVR初始手术后进行的心脏手术的趋势和结果.
分析TAVR后心脏手术的频率和特征.

主要方法:

使用的是胸腔外科医生协会成人心脏手术数据库 (2012年1月至2023年3月).
确定了经过TAVR心脏手术的患者,创建了TAVR后非大动脉手术和外科大动脉置换 (SAVR) 的队列.
检查了描述性统计,趋势分析和30天的结果.

主要成果:

确定了超过5,400名患者;45.5%的患者没有SAVR,54.5%的患者在TAVR后有SAVR.
心脏手术后TAVR显著增加 (总体为4235.3%,每年为144.6%).
手术死亡率为15.5%,中风4.5%;现有的风险模型低估了死亡率.

结论:

心脏手术,包括重复SAVR,TAVR后迅速增加.
相关风险和结果高于当前模型预测的水平.
这些发现应该为心脏团队关于TAVR的决定提供信息,特别是在没有长期证据的年轻或低风险患者中.

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