在没有心脏手术的情况下进行大动脉和 mitra 的结构性干预
Gianmarco Iannopollo1, Alessandro Capecchi1, Roberto Verardi1
1Cardiology Unit, Ospedale Maggiore, Largo Nigrisoli 2, Bologna 40133, Italy.
概括
通过导管的大动脉植入 (TAVI) 可以在没有心脏外科手术的情况下安全地进行,从而改善了接入. 在TRACS试验中,研究了在有或没有现场手术团队的中心的TAVI结果.
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:
- 结构性心脏干预传统上需要在现场进行心脏手术,以获得专业知识和并发症管理.
- 目前的指导方针规定了通过导管的大动脉植入器 (TAVI) 的现场手术,但不规定其他手术,如对心心修复.
- 人口老龄化和TAVI的进步增加了需求,使传统中心承受压力,并造成了获取差距.
研究的目的:
- 评估TAVI在没有现场心脏手术的中心进行的安全性和有效性.
- 为更新关于TAVI中心要求的指南提供证据.
- 探索创新的护理模式,如用于结构性心脏干预的"枢纽与吐槽"方法.
主要方法:
- 随着或没有现场心脏外科手术 (TRACS) 的TRanscatheter主动脉植入试验随机选择高风险的症状主动脉缩患者.
- 患者在有或没有现场心脏外科手术的中心接受相同的操作员的治疗.
- 进行1年的随访以比较结果.
主要成果:
- 观察数据表明,TAVI可以在没有现场心脏手术的情况下安全地进行.
- 塔维手术的并发症率非常低,需要急性心脏手术 (ECS).
- TRACS试验的目的是提供最终的随机数据,以告知指导方针更新.
结论:
- 在没有现场心脏手术的情况下,TAVI有可能在中心安全地进行,从而扩大了患者的访问.
- 在非手术中心中,共享的症状,操作人员能力和强大的网络关系至关重要.
- 需要创新的护理模式,如"Hub-and-Spoke"网络,以满足对结构性心脏干预的日益增长的需求.
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