在爱德华兹·马格纳生物假体中,植入的大小和结构的恶化
Douglas R Johnston1,2, Christopher Mehta1,2, S Christopher Malaisrie1,2
1Division of Cardiac Surgery, Northwestern Medicine and Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, IL, USA.
Annals of cardiothoracic surgery
|June 6, 2024
概括
患者与假肢不匹配,以较高的术后梯度为指标,增加了在用Magna生物假肢更换大动脉后重新干预的风险. 15年后的再干预率仍然很低,但死亡是一个竞争的风险.
科学领域:
- 心血管外科心血管外科
- 生物材料科学 生物材料科学
- 医疗设备工程 医疗设备工程
背景情况:
- 由于患者偏好不接受抗凝药和内透管大动脉置换 (VIV-TAVR) 的兴起,在主动脉置换 (AVR) 中越来越多地使用生物假体门.
- 患者假肢不匹配 (PPM) 是AVR后已知的不良风险,但它对生物假肢门耐用性的影响需要进一步调查.
研究的目的:
- 为了评估马格纳生物假体在AVR后的长期耐用性.
- 评估门大小和血液动力学对Magna生物假体耐用性的影响.
主要方法:
- 追溯性,单一中心研究,对2100名患者进行手术AVR,使用Magna生物假体 (2004年6月 - 2022年12月).
- 从机构登记处收集的数据,包括术后信息和长期后续情况.
- 使用竞争性风险分析估计了不需要重新干预的累积发病率; 用格雷测试进行组对比.
主要成果:
- 随访时间的中位数为5.8年,有116次重复干预 (74次探索,42次VIV-TAVR).
- 所有原因的再干预率为1.2%在5年,4.5%在10年,11.7%在15年.
- 植入物中的更高的平均梯度 (表明PPM) 与延迟重新干预的增加有关 (aHR:1.016;P=0.0047). 较小的门大小与更糟糕的生存率有关,但与重新干预无关.
结论:
- 玛格纳生物假体在15年后显示出低的再干预率,尽管死亡是一个竞争的风险.
- 从生理学上明显的PPM,通过术后升高的门梯度表明,与重新干预的更高风险有关.
- 需要进一步的研究,以了解在需要重新干预的患者中早期狭窄的机制.
相关概念视频
Mitral Valve Prolapse I: Introduction
IntroductionThe mitral valve, one of the heart's four valves, regulates blood flow. These valves have flaps that open and close to direct blood properly through the heart and body. During each heartbeat, the flaps open for blood to pass through and seal shut to prevent backflow. Specifically, the mitral valve opens to allow blood flow from the heart's upper left chamber to the lower left chamber. It then closes securely as the lower left chamber contracts to pump blood to the body, preventing...
Mitral Valve Prolapse II: Assessment and Management
IntroductionA range of clinical features characterizes Mitral Valve Prolapse (MVP), but it is important to note that many individuals with MVP are asymptomatic and may remain so throughout their lives. For those who do exhibit symptoms, the following are the key clinical features:Palpitations: This is a common symptom where individuals feel an irregular or rapid heartbeat. Palpitations in MVP are often due to arrhythmias such as premature ventricular contractions or supraventricular tachycardia.
Mitral Valve Prolapse III: Nursing Management
The nursing management of Mitral Valve Prolapse, or MVP, centers around patient education, symptom monitoring, and lifestyle modifications.Patient Education on MVP Diagnosis and Heredity: Nurses should provide comprehensive education about MVP, a condition where the mitral valve does not close appropriately during heartbeats. This education often includes the condition's pathophysiology, symptoms, and potential complications, like arrhythmias or mitral regurgitation. Though not fully...
Mitral Regurgitation III: Medical Management
Mitral regurgitation (MR) is characterized by retrograde blood circulation from the left ventricle into the left atrium due to inadequate mitral valve closure. The severity of the condition, symptoms, and underlying cause determine treatment strategies.Monitoring and Pharmacological TreatmentPatients with mild to moderate MR typically do not need immediate intervention but regular monitoring to assess progression and guide treatment. Patients with mild MR should have an echocardiogram every 3-5...
Mitral Stenosis III: Medical Management
Mitral stenosis, a condition marked by the narrowing of the mitral valve, necessitates an integrated approach for effective management. This approach includes preventative measures, medical therapy, and surgical interventions to reduce symptoms and prevent complications.PreventionPrevention of mitral stenosis primarily focuses on reducing the incidence of bacterial infections, particularly streptococcal infections, which can lead to rheumatic fever and subsequent valvular damage. Timely...
Aortic Regurgitation III: Medical Management
Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...


