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在跨导管大动脉置换中故意超大门:更大更好吗? 一个大型的,单一的中心体验

Khawaja Afzal Ammar^1,2, Alexandria Graeber¹, Abdur Rahman Ahmad¹

¹Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin, USA.

Structural heart : the journal of the Heart Team

|May 27, 2024

概括

在跨导管大动脉更换中,自膨胀的超大尺寸 (>20%) 显著减少了对膜泄漏. 这种方法可以通过降低与膜漏洞相关的死亡率来改善患者的治疗结果.

科学领域:

心血管医学心血管医学
干预心脏病学干预心脏病学
人造心脏门是一种假心脏门.

背景情况:

目前的跨导管大动脉替换指南 (TAVR) 建议自扩张的超大小为10%至20%.
梅特罗尼克Evolut自扩张通常用于TAVR程序.
超大尺寸超出20%对门性能和患者结果的影响需要进一步调查.

研究的目的:

为了评估TAVR中自扩张门的超大尺寸>20%的有效性和安全性.
为了比较中度 (10%-20%) 和大 (>20%) 的超大小组之间的门性能和并发症率.
为了确定是否增加过大尺寸可以改善TAVR患者的临床结果.

主要方法:

从2011年10月至2016年12月,对556名TAVR患者的回顾性图表审查.
患者被分为两组:中度超大小 (10%-20%) 和大超大小 (>20%).
组间的并发症率包括膜漏洞,心脏起器植入,胃肠道出血,环状解剖和死亡率进行了比较.

主要成果:

较大的超大尺寸 (>20%) 与显著较低的膜漏洞发病率相关 (2.0%对6.1%,OR=0.31,p=0.01).
在心脏起器植入率 (15%对14%) 中没有发现显著差异.
在大型超大小组中,胃肠道出血的发病率较高 (1.3%对0.0%,p=0.03).
死亡率在各组之间是相似的 (1.6%对1.7%).
在死亡的患者中,准膜泄漏的发生率明显高 (13%对1.3%,p≤0.0001).

结论:

在TAVR中超大自膨胀 >20%显著减少了对膜泄漏,而不会增加其他重大并发症.
降低超大尺寸>20%的副膜泄漏发生率,可能会改善患者的存活率.
考虑大于20%的超大尺寸可能是TAVR中对假肢选择的优越策略.

关键词:

复杂性复杂性复杂性结果的结果.植入心脏起器的植入方式准膜泄漏问题通过导管更换大动脉门.

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