超导管与手术大动脉置换的长期结果:随机试验的元分析
Giuseppe Talanas1,2, Angelo Laconi1,2, Dean J Kereiakes3
1Clinical Experimental Cardiology, Clinical and Interventional Cardiology, University of Sassari, Sassari, Italy.
概括
过导管大动脉置换 (TAVR) 在严重的大动脉狭窄症中显示出与手术大动脉置换 (SAVR) 类似的长期结果. TAVR具有更高的起器植入率,特别是自扩张门.
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:
- 严重的大动脉狭窄需要门置换,通过导管大动脉门置换 (TAVR) 和手术大动脉门置换 (SAVR) 作为主要选择.
- 虽然TAVR证明了短期的有效性和安全性,但与SAVR相比,其长期的结果仍然不太清楚.
研究的目的:
- 进行随机对照试验的元分析,比较TAVR与SAVR在重度大动脉狭窄患者的长期结果.
- 评估死亡或致残性中风的主要终点,以及包括死亡率,中风,心脏起器植入,膜血栓,梯度和膜漏洞在内的二次终点.
主要方法:
- 随机对照试验的系统审查和元分析,随着最长的可用随访.
- 包括7项试验,共计7785名患者,加权平均随访时间为5.76年.
- 主要结局:死亡或残疾性中风. 二次结局:全因死亡率,心脏死亡率,中风,心脏起器植入,膜血栓,膜梯度和中度至严重的准膜泄漏.
主要成果:
- 在TAVR和SAVR之间死亡或致残性中风的复合终点没有显著差异 (HR,1.02;95% CI,0.93-1.11;P = .70).
- 与SAVR相比,TAVR与更高的起器植入率和中度至重度的准膜泄漏有关.
- 与气球可扩展的TAVR相比,自我扩展的TAVR显示出较低的死亡或中风风险和膜血栓形成的趋势,但与更高的起器植入率相比.
结论:
- 死亡或致残性中风的长期风险与TAVR和SAVR在严重的大动脉狭窄症中相似.
- TAVR与心脏起器植入的风险增加有关,特别是自扩张类型.
- 与气球可扩展的TAVR相比,自我扩展的TAVR在降低死亡/中风风险和膜血栓形成方面表现出潜在的优势,尽管心脏起器率更高.
更多相关视频
相关概念视频
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 II: Clinical Features and Diagnostic Tests
Aortic valve regurgitation (AR) occurs when the aortic valve fails to close properly, allowing blood to flow backward from the aorta into the left ventricle. This backflow can result in two distinct clinical presentations: acute and chronic AR, each characterized by its own set of symptoms and physical findings.Acute Aortic RegurgitationAcute AR presents with a sudden onset of severe symptoms. Patients typically experience profound dyspnea (shortness of breath), chest pain, and signs of left...
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...


