在患有低流量,低梯度的大动脉狭窄症的患者中,手术和跨导管大动脉置换的结果
James A Brown1, Eishan Ashwat1, Nav Warraich1
1Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa; Division of Cardiology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pa.
概括
手术和透气管大动脉置换显示,在患有低流量,低梯度大动脉狭窄症的患者中,长期结果类似. 两种方法在死亡率和心力衰竭再入院方面都提供了可比的结果,尽管在程序并发症方面存在差异.
科学领域:
- 心脏病学 心脏病学
- 心脏外科手术 心脏外科手术
- 干预心脏病学 干预心脏病学
背景情况:
- 严重的大动脉狭窄带来了挑战,特别是低流量,低梯度亚型.
- 了解外科动脉置换 (SAVR) 和透气管动脉置换 (TAVR) 的比较有效性对于最佳的患者管理至关重要.
研究的目的:
- 为了比较SAVR与TAVR的长期结果,在被诊断为低流量,低梯度的大动脉狭窄的患者中.
- 为了评估两种手术组之间的死亡率,中风,心脏起器植入和心力衰竭再入院率.
主要方法:
- 一项观察性研究包括575名患者,这些患者因低流量,低梯度的大动脉狭窄症 (平均梯度<40毫米升,中风体积指数<35毫升/米2) 接受了孤立的,首次的大动脉置换.
- 患者被分为SAVR (n=131) 和TAVR (n=117) 组,其中TAVR患者年龄大得多.
- 评估了包括30天死亡率,中风,起器,准膜泄漏和1年的门功能在内的结果.
主要成果:
- 在SAVR和TAVR组之间在30天死亡率,中风或心脏起器率方面没有发现显著差异.
- 超导管大动脉置换与较高的准膜泄漏发生率有关.
- 在1年的随访中,大动脉的平均梯度和射出分数在两组之间是可比的.
- 与SAVR相比,多变量分析表明TAVR与死亡或心力衰竭再入院的风险增加无关.
结论:
- 手术和透气管大动脉置换似乎对患有低流量,低梯度大动脉狭窄症的患者同样有效.
- 在这个患者队列中,SAVR和TAVR的长期结果,包括死亡率和心力衰竭再入院,是可比的.
- 虽然在TAVR中对膜漏洞更为常见,但整体的长期结果表明程序等价性.
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