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超导管与手术大动脉置换在双大动脉中

J Hunter Mehaffey¹, Vikrant Jagadeesan², Mohammad Kawsara²

¹Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia.

The Annals of thoracic surgery

|December 11, 2024

概括

在双主动脉 (BAV) 患者中,过导管大动脉置换 (TAVR) 与手术大动脉置换 (SAVR) 相比,在医院内死亡率较低,但中风和长期死亡风险较高. 这种趋势甚至在年轻,低风险的患者中仍然存在.

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:

超导管大动脉置换 (TAVR) 越来越多地用于双管大动脉 (BAV) 患者,这个群体以前被排除在比较试验之外.
现实世界的数据对于理解TAVR与手术大动脉置换 (SAVR) 在BAV中的结果至关重要.

研究的目的:

为了比较TAVR与SAVR在BAV患者的外科和纵向结果.
为了评估年轻,低风险的BAV患者的一个子组的结果.

主要方法:

美国医疗保险数据 (2018-2022) 对于BAV患者中孤立的SAVR或TAVR的回顾性分析.
使用反向概率加权和多层次回归,对并发症和脆弱性进行两倍强大的风险调整.
对75岁以下的低手术风险患者进行竞争性风险时间到事件分析和亚组分析.

主要成果:

这项研究包括11,289名BAV患者 (8123名SAVR,3166名TAVR).
与SAVR相比,TAVR与较低的手术死亡率有关,但与SAVR相比,心脏起器植入,纵向中风和全因死亡率较高.
在年轻的低风险小组中观察到类似的发现,TAVR显示较高的纵向中风和中风,再干预或死亡的复合.

结论:

在BAV的医疗保险受益者中,TAVR提供了较低的住院死亡率.
然而,TAVR与SAVR相比,与5年风险调整后的纵向中风率更高有关.
这些发现甚至适用于最年轻,风险最低的BAV患者.

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