大动脉狭窄和冠状动脉疾病:手术和透导管治疗之间的决策
Daijiro Tomii1, Thomas Pilgrim1, Michael A Borger2
1Department of Cardiology (D.T., T.P., J.L., S.W.), Cardiovascular Center, Bern University Hospital, Inselspital, University of Bern, Switzerland.
Circulation
|December 16, 2024
概括
治疗大动脉狭窄症 (AS) 和冠状动脉疾病 (CAD) 的患者需要仔细考虑治疗选择,包括手术和透气大动脉置换 (TAVR). 心脏团队必须对个体患者的因素进行权衡, 以确定最佳的复血管化策略.
科学领域:
- 心脏病学
- 干预心脏病学
- 心脏外科
背景情况:
- 大动脉狭窄 (AS) 和冠状动脉疾病 (CAD) 经常同时存在.
- 对需要再血管化的AS和CAD患者的最佳治疗策略仍然不确定.
- 传统的动脉置换手术和冠状动脉绕道移植正在面临新的挑战.
研究的目的:
- 审查支持AS和CAD患者决策的证据.
- 通过导管大动脉置换 (TAVR) 探索扩展的治疗选择.
- 根据疾病严重程度和临床表现来指导治疗选择.
主要方法:
- 审查目前的临床证据和治疗途径.
- 用冠状动脉旁道移植和不用冠状动脉旁道移植进行外科动脉置换的结果分析.
- 评估涉及TAVR和穿皮冠状动脉干预 (PCI) 的新兴策略.
主要成果:
- 结合性大动脉置换和冠状动脉旁路移植改善了复杂CAD的长期死亡率,但增加了周围手术风险.
- 通过导管的大动脉置换 (TAVR) 引入了替代途径,如TAVR前的再血管化,同时进行TAVR/PCI或TAVR后的PCI.
- 在TAVR患者中PCI的影响不太确立,并且不支持统一的策略.
结论:
- 对AS和CAD的治疗选择取决于疾病的严重程度,抗血栓策略和临床表现.
- 心脏团队需要通过导管和手术方法获得全面的数据, 以获得最佳的患者护理.
- 由于AS和CAD联合管理的复杂性和不确定性,个性化治疗计划至关重要.
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