死亡率和资源利用在外科手术与跨导管重复的 mitra 置换:一个国家分析
Nguyen K Le1,2, Nikhil Chervu1,3, Saad Mallick1
1Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America.
PloS one
|May 23, 2024
概括
透气管中门置换 (TMVR) 与手术置换 (SMVR) 的死亡率相似,但复杂性更少,重复手术成本更低. 穿越性TMVR显示出改善的结果,但与穿越性方法相比,费用更高.
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
- 卫生经济学 卫生经济学
背景情况:
- 过导管 mitra 置换 (TMVR) 正在成为需要重复手术的高风险患者手术性 mitra 置换 (SMVR) 的替代方案.
- 重制中门手术存在重大风险,需要评估新的治疗方案.
研究的目的:
- 评估TMVR与临床和财务结果的关联,与SMVR相比,在接受隔离重复中门置换的患者中评估TMVR与临床和财务结果的关联.
- 为了在TMVR队列中比较跨septal和跨apical导管式方法.
主要方法:
- 使用2016-2020年全国再接收数据库进行的回顾性队列研究.
- 包括接受隔离重复中枢置换的成年患者,分为TMVR和SMVR组.
- 应用回归模型来分析住院死亡率,二次临床结果,住院时间和成本.
主要成果:
- 与SMVR相比,TMVR与类似的住院死亡率有关,但中风,长时间通风,急性损伤和重新手术的几率明显较低.
- TMVR证明了术后停留时间缩短和总体成本降低.
- 在TMVR中,穿越视线的方法显示调整后死亡率较低,停留时间较短,但成本比穿越视线的方法更高.
结论:
- TMVR是重复中膜手术的安全和具有成本效益的选择,其死亡率与SMVR相当,临床结果得到改善,开支减少.
- 跨septalTMVR提供了生存和长度停留的好处超过跨apical,尽管成本增加.
- 需要进一步的研究,以评估TMVR和SMVR的长期结果.
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