晚期转诊和三回的高死亡率:呼吁及时干预
Julius Jelisejevas1,2,3, Ali Husain4, Brian Chiang1,2
1Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada V6T 1Z3.
European heart journal open
|June 27, 2025
概括
晚些时候转诊的三回 (TR) 患者面临高死亡率. 对TR的早期转诊和干预可以改善结果并降低死亡率.
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:
- 三腹 (TR) 显著增加了患者的发病率和死亡率.
- 对TR患者的转诊和干预的最佳时间尚不清楚,导致治疗延迟.
研究的目的:
- 为了评估TR患者的结局,这些患者被转诊进行三巴干预.
- 为了比较接受干预的患者和没有干预而死亡的患者之间的结果.
主要方法:
- 分析了从2018年5月到2023年4月连续58名被转诊TR干预的患者队列.
- 患者分为两组:第一组 (经过过导管端到端的修复或过导管更换) 和第二组 (无干预死亡).
- 关键的终点包括住院患者,30天,12个月和18个月的死亡率,心脏起器植入,TR分级,NYHA类和心力衰竭再入院.
主要成果:
- 在58名患者中,43人接受了干预 (29名TTVR,14名T-TEER),而15人没有进行干预就死亡.
- 干预组 (第一组) 的12个月死亡率为33%,非干预组 (第二组) 的死亡率为73%.
- 18个月后,死亡率在第一组为37%,在第二组为100%. 后来转诊的患者已经发展出显著的并发症.
结论:
- 对TR的转诊往往发生晚期,在出现了大量的并发病后,导致高死亡率.
- 应在较早的阶段考虑三门干预,以改善患者的治疗结果.
- 及时的转诊和干预对于管理TR和降低相关死亡率至关重要.
相关概念视频
01:15Aortic Regurgitation I: Introduction
45
IntroductionAortic regurgitation is characterized by the backward flow of blood from the aorta into the left ventricle during diastole and arises from the improper closure of the aortic valve. This condition results in left ventricular volume overload and can stem from both acute and chronic etiologies, each contributing uniquely to the disease's progression and symptomatology.Acute and Chronic CausesAcute aortic regurgitation often results from events that suddenly impair the integrity of the...
45
01:22Aortic Regurgitation II: Clinical Features and Diagnostic Tests
59
Aortic valve regurgitation (AR) occurs when the aortic valve fails to close properly, allowing blood to flow backward from the aorta into the left ventricle. This backflow can result in two distinct clinical presentations: acute and chronic AR, each characterized by its own set of symptoms and physical findings.Acute Aortic RegurgitationAcute AR presents with a sudden onset of severe symptoms. Patients typically experience profound dyspnea (shortness of breath), chest pain, and signs of left...
59
01:17Aortic Regurgitation IV: Nursing Management
63
A nurse managing a patient with aortic regurgitation begins with a comprehensive assessment, including a review of the patient's medical history, family history, and lifestyle factors. During the cardiac examination, the nurse listens for heart sounds and checks for signs of valve abnormalities. The nurse also observes for symptoms such as dyspnea, orthopnea, and paroxysmal nocturnal dyspnea and assesses the patient's endurance and daily activity tolerance.Based on the findings, the nurse...
63
01:28Mitral Regurgitation IV: Nursing Management
92
Mitral regurgitation (MR) is a condition where the mitral valve does not close properly, leading to the backward flow of blood from the left ventricle into the left atrium during systole. This condition can arise from various causes, including rheumatic fever, infective endocarditis, or degenerative valve disease. Effective nursing management is crucial to optimizing patient outcomes and involves comprehensive assessment and targeted interventions.Comprehensive Patient AssessmentA detailed...
92
01:20Mitral Regurgitation I: Introduction
64
Mitral regurgitation is characterized by the backward circulation of blood from the left ventricle to the left atrium during systole, a phase of the cardiac cycle when the heart contracts and pumps blood out of the chambers. This abnormal flow occurs primarily due to the dysfunction of the mitral valve or its supporting structures, which include the mitral leaflets, chordae tendineae, annulus, and papillary muscles.Etiology and Mechanisms:Primary Mitral Regurgitation: This type arises from...
64
01:25Mitral Regurgitation III: Medical Management
34
Mitral regurgitation (MR) is characterized by retrograde blood circulation from the left ventricle into the left atrium due to inadequate mitral valve closure. The severity of the condition, symptoms, and underlying cause determine treatment strategies.Monitoring and Pharmacological TreatmentPatients with mild to moderate MR typically do not need immediate intervention but regular monitoring to assess progression and guide treatment. Patients with mild MR should have an echocardiogram every 3-5...
34