与老年患者的外科手术相比,穿透管边缘与边缘相比,老年患者有退行性米特拉反
Gaspard Suc1,2,3,4, Rebecca Hadjedj5,6,7, Jules Mesnier5,6,7
1Cardiology Bichat, AP-HP, Paris, France. gaspard.suc@aphp.fr.
Journal of cardiothoracic surgery
|January 15, 2025
概括
与手术相比,超导管边缘到边缘修复 (TEER) 显示,在老年患者中,严重的额叶吐 (MR) 最初的不良事件比手术更高. 然而,考虑到患者因素和残留MR,结果的差异并不显著.
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:
- 严重的退行性额回 (MR) 影响老年患者,手术和跨导管端到端修复 (TEER) 作为治疗选择.
- 现实世界的数据对于比较这些干预措施在老年人群中的有效性至关重要.
研究的目的:
- 为了比较手术修复/更换中枢的一年期结果与65岁及以上患有严重退行性MR的患者的TEER.
- 确定影响这些患者群体结果的因素.
主要方法:
- 在2013年至2023年间,对295名连续患者 (≥65岁) 进行了回顾性分析,这些患者患有严重的症状退行性MR,接受了手术或TEER治疗.
- 排除标准包括二次性MR和活跃内心炎.
- 主要结局是综合所有原因死亡率,心力衰竭住院治疗或在一年内进行心交膜再干预.
主要成果:
- 与手术组相比,TEER组 (92名患者) 在一年内 (20%) 的初级综合结局率高于手术组 (4%,p < 0.01).
- 与不良结果相关的因素包括残留MR>2,心脏手术前,BMI和基线TR>2.
- 经过对包括残留MR在内的混因素进行调整后,TEER和手术之间的初级结局差异在统计学上并不显著 (aHR:3.41,p = 0.15).
结论:
- 最初,TEER与严重退行性MR患者的老年患者的不良事件比手术更多.
- 这些差异主要归因于患者的基线特征和残留MR严重程度.
- 一旦对这些因素进行调整,干预类型 (TEER与手术) 并没有显著影响一年的结果.
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