在低和中等的外科风险人群中,用于严重的大动脉狭窄的TAVR与SAVR:更新的元分析,元回归和试验顺序分析
Mrinal Murali Krishna1, Meghna Joseph2, Chidubem Ezenna3
1Department of Medicine, Medical College Thiruvananthapuram, India. Electronic address: https://twitter.com/MrinalMkrishna.
概括
在低风险患者中,透气管大动脉置换 (TAVR) 的死亡或中风率低于外科大动脉置换 (SAVR). 然而,TAVR具有更高的心脏起器植入和门问题的风险,这引发了长期安全问题.
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:
- 目前的指导方针建议在65岁以上的患者进行透气管大动脉置换 (TAVR) 或手术大动脉置换 (SAVR).
- 在低风险和中等风险的手术患者中,TAVR与SAVR的风险和益处的比较尚未完全理解.
研究的目的:
- 系统地比较TAVR和SAVR在患有严重大动脉狭窄和低至中等手术风险的患者的临床结果.
- 评估这两种主要的大动脉置换策略的相对安全性和有效性.
主要方法:
- 在PubMed,Scopus和Cochrane Central数据库中进行了系统的文献搜索.
- 包括的研究是随机对照试验 (RCT),直接比较特定患者群体中的TAVR和SAVR.
- 分析了涉及9239名患者的10个RCT的数据.
主要成果:
- 与SAVR相比,TAVR在30天和1年的随访期间显示出所有原因死亡或中风的比例明显较低.
- TAVR与减少出血并发症,新发性心房动,急性损伤和严重的患者假肢不匹配有关.
- 相反,TAVR在两个时间点都显示了更高的永久心脏起器植入率,大动脉重新干预,主要血管并发症和准膜泄漏.
结论:
- 对于患有严重大动脉狭窄和低至中等的手术风险的患者,TAVR提供了短期的优势,包括降低死亡率,中风,出血和急性损伤,相比SAVR.
- 尽管有这些好处,但永久性起器植入率的增加,对膜泄漏和TAVR的重新干预需要仔细考虑其长期安全性,特别是在年轻,风险较低的个体中.
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