大动脉同移植变性:重复大动脉置换的手术或透导管方法?
Sven Peterss1,2, Thomas G Fabry1,2, Julius Steffen3,4
1University Aortic Centre Munich, LMU University Hospital, Munich, Germany.
概括
过导管大动脉置换 (TAVR) 为退化的大动脉同移植提供了对外科大动脉置换 (SAVR) 的有利替代方案,显示了改善的恢复和可比的生存率. 由于其可访问性和短期到中期的良好结果,人们更喜欢TAVR.
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
- 生物材料科学 生物材料科学
背景情况:
- 大动脉合移植 (同移植) 用于大动脉置换,其目的是比机械或生物假肢具有更高的耐用性.
- 同体移植变性需要重新干预,这往往是复杂的显著的大动脉壁化.
- 之前的同种植器失败为重复的大动脉门手术带来了独特的挑战.
研究的目的:
- 为了比较患有退化的大动脉同种移植的患者的开放性外科大动脉置换 (SAVR) 和跨导管大动脉置换 (TAVR) 的结果.
- 在一个具有挑战性的患者群体中评估重置大动脉手术的疗效和安全性.
主要方法:
- 在1993年至2022年期间,对81名患者进行了回顾性分析,这些患者在之前的同移植植入后经历了重复的大动脉手术.
- 患者被分为两组:接受了开放式外科动脉置换 (SAVR) 的患者和接受过导管动脉置换 (TAVR) 的患者.
- 重复手术主要用于严重吐 (85%) 或狭窄 (15%) 的退化的同种植物.
主要成果:
- 与SAVR相比,通过导管的大动脉置换 (TAVR) 在长时间通风 (0% vs. 21%),ICU停留 (1 vs. 2天) 和整体住院 (10.5 vs. 13天) 方面表现明显好.
- 在TAVR (0%) 和SAVR (7%) 之间,三十天死亡率是可比的,尽管在统计学上不显著.
- 在TAVR和SAVR组之间,五年生存率在统计学上是相似的,在两组中都没有观察到严重的膜泄漏病例.
结论:
- 对于退化的同体移植,手术性大动脉置换 (SAVR) 产生了可接受的结果,但带来了实质性和不可预测的术后风险.
- 过导管大动脉置换 (TAVR) 提供了一个更容易获得和合理的替代方案,与有利的短期和中期结果相关.
- 鉴于目前的证据,TAVR被认为是退化的大动脉同移植患者的首选治疗选择,除非有特定的禁忌.
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