在患有小主动脉环的患者中,通过导管进行双或三主动脉置换:一项观察性研究
Wenjing Sheng1,2,3, Jiaqi Fan1,2,3, Jun Chen1,2,3
1Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Open heart
|June 13, 2025
概括
通过导管的大动脉置换 (TAVR) 显示了类似的临床和血液动力学结果双和三大动脉狭窄 (AS) 患者小 annuli. 精心规划支持TAVR扩展在选择双骨神经系统病例.
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:
- 严重的大动脉狭窄 (AS) 影响双大动脉 (BAV) 和三大动脉 (TAV) 种群.
- 小型大动脉环形对跨导管大动脉置换 (TAVR) 提出了独特的挑战.
- 在小环状的TAVR中,BAV和TAV之间的比较结果需要进一步调查.
研究的目的:
- 为了比较TAVR的临床结果和血液动力学性能,在患有严重AS和小环形的患者中,按大动脉形态分层 (双形与三形).
主要方法:
- 对427名患者 (193名BAV,234名TAV) 的前性观察队列的回顾性分析,这些患者因症状严重的AS和小环形 (中位面积381.5毫米2) 接受TAVR治疗.
- 使用了手术前多重检测器CT和标准化心声回声学随访.
- 使用Cox回归进行混调整,比较了基线特征,技术成功,并发症,血液动力性能,生物假体功能障碍 (BVD) 和1年的重大心脏和脑血管不良事件 (MACCE).
主要成果:
- 与TAV相比,BAV接受者具有更高的技术故障率 (11.4%对6.0%),但永久心脏起器植入率较低 (4.7%对12%).
- 一年后的MACCE率相似 (14.5%与9.8%),在考克斯回归后没有显著差异 (HR 1.408).
- 两组均表现出改善的血液动力学,可比的BVD率 (11.4%与9.2%) 和相当的长期存活率 (HR 0.950).
结论:
- TAVR为双管和三管AS提供了可比的临床和血液动力学结果,其中包括小主动脉环.
- 尽管BAV案件的程序复杂性较高,但TAVR是一个可行的选择.
- 这些发现支持对TAVR的谨慎扩展,以选择经过细致的程序规划的BAV患者.
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