跨导管大动脉置换后的准膜反:发生率,量化和预后影响
Marleen van Wely1, Maxim Rooijakkers1, Niels Stens1,2
1Department of Cardiology, Radboudumc, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
European heart journal. Imaging methods and practice
|July 24, 2024
概括
过导管大动脉置换 (TAVR) 后的副膜吐 (PVR) 是常见的,增加死亡风险. 像扩张后或装置植入等治疗选择可以有效地减少PVR并改善结果.
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
- 医疗器械技术 医疗器械技术
背景情况:
- 透气管大动脉置换 (TAVR) 是对大动脉狭窄的标准治疗方法,其结果与手术置换相当.
- 垂回 (PVR) 仍然是TAVR后的重大并发症,即使在低风险试验中,也影响了大约30%的患者.
- PVR与整体和心血管死亡率的风险增加有关,并且可以在患有先前存在的疾病的患者中加剧心力衰竭.
研究的目的:
- 为了审查发生率,预测因子,诊断方法和管理策略,对横导管大动脉置换 (TAVR) 后的膜反 (PVR).
- 突出PVR对患者结局和死亡率的影响.
- 讨论TAVR后PVR的当前和新兴治疗选择.
主要方法:
- 对TAVR和PVR研究的文献综述.
- 分析诊断方式,包括心声学,大动脉血管学,血液动力学评估和心脏MRI.
- 评估治疗策略,如扩张后,血管塞植和第二个装置植入等.
主要成果:
- 轻度PVR在TAVR后很常见,中度或重度PVR的发病率由于设备和技术的改进而减少.
- 预测PVR的因素包括环状异常度,严重化,双门和假肢类型 (气球可扩展设备显示PVR较少).
- 治疗选择,如扩张后 (取决于气球大小) 和第二个装置植入 (成功率为~90%) 或血管塞植入,可以有效地降低PVR和死亡率.
结论:
- 尽管取得了进展,但PVR仍然是TAVR之后的一个担忧,与死亡率增加有关.
- 准确的诊断和及时的干预对于管理PVR至关重要.
- 干预策略,包括设备植入和血管塞,为减少PVR和改善患者存活率提供了有效的解决方案.
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