在4年或更长的时间内,在低风险患者中进行过导管大动脉置换
John E Connolly1, Seyed Hossein Aalaei Andabili1, Emily Joseph1
1Department of Medicine, Division of Cardiology, The Johns Hopkins Hospital, Baltimore, Md.
The American journal of medicine
|June 14, 2024
概括
在低风险患者中,透管大动脉置换 (TAVR) 显示了与手术大动脉置换 (SAVR) 相似的长期结果. 这两种手术都是严重的大动脉狭窄的安全替代方案.
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:
- 过导管大动脉置换 (TAVR) 是手术大动脉置换 (SAVR) 的一个成熟的替代方案.
- 之前的研究表明,TAVR在中期和高风险患者中提供了可比或优异的结果.
- 关于低手术风险个体的长期TAVR与SAVR结果的数据有限.
研究的目的:
- 为了比较TAVR和SAVR的长期结果,在患有严重症状大动脉狭窄症的患者中,这些患者的外科风险较低.
- 评估TAVR和SAVR之间的重大不良事件和重新干预率在这个特定的患者队列中.
主要方法:
- 进行了一项随机对照试验 (RCT) 的系统审查,比较低风险患者的TAVR和SAVR.
- 使用随机效应模型的元分析来评估关键结果.
- 包括的结局是全因死亡率,心血管死亡率,中风,心肌梗塞和大动脉膜再干预.
主要成果:
- 分析包括来自三个RCT的2,644名患者 (1,371名TAVR,1,273名SAVR).
- 在长期随访中,在TAVR和SAVR组之间,在所有原因的死亡率,心血管死亡率,中风,心肌梗塞或重新干预方面没有发现显著差异.
- TAVR与更高的心脏起器植入率有关,而SAVR则有更多的心房动病例.
结论:
- 在低手术风险的患者中,透气管大动脉置换 (TAVR) 证明了与手术大动脉置换 (SAVR) 相比的安全性和长期疗效.
- 这些发现支持对TAVR和SAVR的共享决策,考虑个别风险和收益.
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