紧急与选择性跨导管大动脉置换患者的死亡率:元分析
Anastasios Apostolos1, Nikolaos Ktenopoulos1, Dimitrios-David Chlorogiannis2
1First Department of Cardiology, Medical School, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
Angiology
|April 13, 2024
概括
对于严重的大动脉狭窄而言,紧急过导管大动脉置换 (TAVR) 会增加30天的死亡率和急性损伤等并发症. 在稳定的患者中,早期TAVR对于更好的结果至关重要.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 健康 结果 研究 研究 结果
背景情况:
- 严重的大动脉狭窄症 (AoS) 经常导致急性心力衰竭和心脏性休克.
- 超导管大动脉置换 (TAVR) 越来越多地被用作危急病患者的救助策略.
- 在不稳定的患者中,紧急的TAVR需要仔细比较选择性手术.
研究的目的:
- 为了比较紧急TAVR与选择性TAVR在严重大动脉狭窄患者的结果.
- 评估30天死亡率,住院死亡率和其他关键的手术并发症.
主要方法:
- 在三个数据库中进行系统的文献搜索,以进行比较研究.
- 十七项涉及84,495名患者的研究的元分析.
- 主要终点:30天死亡率. 二级终点:住院死亡率,装置成功,血管并发症,中风,急性损伤 (AKI),永久心脏起器植入 (PPM),副膜泄漏和出血.
主要成果:
- 紧急TAVR与显著更高的30天死亡率 (RR:2.53) 和住院死亡率 (RR:2.67) 相关.
- 随着紧急TAVR,观察到周围手术血管并发症 (RR: 1.91) 和急性损伤 (AKI) (RR: 2.83) 的风险增加.
- 在设备的成功,中风,PPM,准膜泄漏或出血方面没有发现显著差异.
结论:
- 与选择性TAVR相比,紧急TAVR的死亡和并发症风险更高.
- 增加AKI和血管并发症的发生率可能会导致紧急TAVR的较差结果.
- 这些发现强调了在稳定的大动脉狭窄患者中及时进行TAVR的重要性,以优化结果.
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