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目前关于在生物假肢大动脉替换后血液动力学结构恶化的定义缺乏一致性

Bart J J Velders¹, Michiel D Vriesendorp¹, Federico M Asch^2,3,4,5,6,7

¹Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.

|July 17, 2024

概括

血液动力学结构损坏的新定义显示,在进行大动脉置换手术后的病例分类方面存在不一致. 这些定义很难在手术后五年内检测到真正的膜退化.

科学领域:

心脏病学心脏病学
生物医学工程生物医学工程
医疗器械医疗器械

背景情况:

手术大动脉置换 (SAVR) 是对大动脉疾病的常见手术.
血液动力学结构恶化 (SVD) 可以影响SAVR后的长期结果.
对血液动力学SVD的标准化定义对于一致的患者管理和研究至关重要.

研究的目的:

评估血动力学SVD的建议心声回声学定义的一致性.
评估这些定义在5年期间在SAVR之后对SVD进行分类时的表现.

主要方法:

一项多中心前性队列研究包括1118名接受SAVR治疗的患者,使用相同的支架生物假体.
一个独立的核心实验室评估了心声学参数.
使用卡波达诺,德维尔和门学术研究联盟3 (VARC-3) 的标准来定义静脉动力学SVD.

主要成果:

在很少一部分患者中发现了血液动态性SVD:4.6% (Capodanno),2.9% (Dvir) 和3.0% (VARC-3).
绝大多数 (95%) 的患者在研究期间从未达到任何SVD定义.
最初被归类为SVD的高比例患者在随后的随访中没有被重新归类为SVD (59-65%).

结论:

目前对血液动力学SVD的定义是检测狭窄性SVD的不一致的积极区分器.
心声学指数在SAVR后的前5年中缺乏准确性来诊断SVD.
这些定义的不一致性挑战了它们在识别真正的膜退化方面的临床实用性.

关键词:

生物假肢大动脉替换器超声心电图 (Echocardiography) 是一种心声回声仪.血液动力学结构的恶化

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