什么时候在TAVI患者中进行皮革冠状动脉干预? 最近的进展是最近的进步
Mattia Lunardi1, Francesco Bianchini1, Cristina Aurigemma1
1Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Kardiologia polska
|August 14, 2024
概括
冠状动脉疾病 (CAD) 是常见的严重的大动脉狭窄患者接受过导管大动脉植入 (TAVI). 在TAVI之前或之后,最佳的CAD管理需要一个量身定制的方法,需要进一步的研究来制定最终的指南.
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:
- 冠状动脉疾病 (CAD) 影响大约50%的患有严重的大动脉狭窄症的患者接受过导管大动脉植入 (TAVI).
- CAD对TAVI结果的影响以及其管理的最佳时机仍然不清楚.
- 有效的CAD评估和治疗策略对于优化TAVI患者的临床结果和资源利用至关重要.
研究的目的:
- 审查评估TAVI患者CAD的最新证据.
- 确定CAD治疗的最佳时间,以改善TAVI的结果.
- 讨论目前在这个人群中CAD的诊断方法和再血管化策略.
主要方法:
- 对TAVI候选人的CAD诊断现有证据的审查.
- 对侵入性冠状动脉血管学 (ICA) 和冠状动脉计算机断层扫描血管学 (CCTA) 的讨论.
- 评估功能评估指数,如分量流量储备 (FFR) 和即时无波比 (iFR),以指导再血管化.
主要成果:
- ICA是TAVI候选人的CAD严重性评估的标准,但CCTA可以减少不必要的ICA程序.
- 在大动脉狭窄患者中,FFR似乎比iFR更可靠,特别是在TAVI后.
- 在TAVI之后的穿皮冠状动脉干预 (PCI) 与TAVI前的PCI相比,可能会提供更好的结果.
结论:
- 在TAVI患者中最佳的CAD管理需要个性化策略.
- 基于个体患者因素考虑TAVI前后的PCI是目前的证据支持的.
- 需要进行进一步的随机试验,以确定TAVI患者CAD治疗的最终指南.
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