在65岁及以上的患者中,进行手术或通过导管进行大动脉置换
Stanley Wolfe1, Vikrant Jagadeesan2, Lawrence Wei1
1Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia.
The Annals of thoracic surgery
|February 27, 2025
概括
手术性大动脉置换 (SAVR) 在低风险和中等风险患者中显示出比透气管大动脉置换 (TAVR) 更好的长期结果. 虽然SAVR的初始死亡率较高,但在五年内,它导致了更大的免于死亡,中风或重新干预的自由.
科学领域:
- 心血管医学 心血管医学
- 干预心脏病学 干预心脏病学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 现在通过导管的大动脉置换 (TAVR) 已被批准用于所有风险概况,扩大其使用范围超出临床试验人群.
- 在不同的医疗保险受益人群中,TAVR与外科动脉置换 (SAVR) 的现实结果需要评估.
研究的目的:
- 为了比较不同风险层的医疗保险受益人中SAVR和TAVR的当代现实世界结果.
- 为临床决策和患者咨询提供有关大动脉置换策略的信息.
主要方法:
- 美国医疗保险服务中心数据库对65-85岁的患者进行分析,这些患者在2018-2022年期间接受了首次隔离SAVR (n=34,215) 或TAVR (n=124,897).
- 根据包括脆弱性在内的预测死亡率,将风险分为低,中等和高的分层.
- 采用了两倍强大的风险调整和竞争风险的时间到事件分析.
主要成果:
- 在所有风险组中,SAVR与更高的住院死亡率,急性损伤和出血有关,但心脏起器率低于TAVR.
- 在五年内,SAVR在低风险和中等风险患者中表现出较高的免于复合死亡,中风或门再干预的自由性.
- 与TAVR相比,SAVR在低和中等风险患者中对中风的整体再入院率也较低.
结论:
- 在低风险和中等风险的医疗保险受益者中,SAVR提供了优越的长期免于死亡,中风或门再干预,尽管住院死亡率更高.
- 这些发现支持加强心脏团队的决策和对大动脉置换患者的咨询.
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