过导管或为失败的生物假体大动脉门进行手术替换
Jessica H Tran1,2, Shinobu Itagaki1,2, Qi Zeng2
1Department of Cardiovascular Surgery, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York.
JAMA cardiology
|May 22, 2024
概括
内透管大动脉置换 (ViV-TAVR) 的早期并发症比手术置换 (SAVR) 的早期并发症少. 然而,ViV-TAVR与晚期死亡率和心力衰竭住院病例的增加有关.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 心脏外科手术 心脏外科手术
背景情况:
- 在失败的生物假体手术大动脉置换 (SAVR) 时,使用内透管大动脉置换 (ViV-TAVR) 正在增长.
- 将ViV-TAVR与重制SAVR进行比较的长期数据有限.
研究的目的:
- 为了比较ViV-TAVR和重复SAVR之间的死亡率和发病率,在患有生物假体大动脉的患者中进行重复SAVR.
- 评估ViV-TAVR的安全性和有效性,作为SAVR重复的替代方案.
主要方法:
- 对1771名接受ViV-TAVR或重复SAVR的患者进行了回顾性,基于人口的队列分析 (2015-2020年).
- 倾向匹配创造了375个患者对进行比较.
- 主要结局:全因死亡率. 二次结局:中风,心力衰竭住院,重新手术,出血,功能衰竭,心脏起器插入,传染性内心炎.
主要成果:
- 与重复SAVR相比,ViV-TAVR在周围过程中出现较低的严重出血,急性功能衰竭和新的起器植入率.
- 所有原因的死亡率在2年内是相似的,但在2年后使用ViV-TAVR时更高 (HR,2.97).
- ViV-TAVR与较高的晚期心力衰竭住院率有关 (HR,3.81).
结论:
- 与重复SAVR相比,ViV-TAVR提供了较少的周围手术并发症.
- 虽然早期死亡率相似,但ViV-TAVR与晚期死亡率增加和心力衰竭住院治疗有关.
- 需要进一步调查,可能通过随机试验,以证实这些发现,因为可能存在残留混.
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