在患有严重大动脉动脉瘤的患者中进行过导管大动脉置换后的长期结果
Shinnosuke Kikuchi1, Antonin Trimaille1, Adrien Carmona2
1Department of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France; UR 3074 Translational Cardiovascular Medicine, CRBS, University of Strasbourg, France.
The American journal of cardiology
|July 15, 2025
概括
严重的大动脉动脉瘤显著增加了大心脏和脑血管重大不良事件 (MACCE) 的风险在两年内通过导管大动脉置换 (TAVR). 这包括较高的缺血性中风和心血管死亡率,影响了早期和晚期的结果.
科学领域:
- 心血管医学 心血管医学
- 干预心脏病学 干预心脏病学
- 医疗成像医学成像
背景情况:
- 大动脉动脉瘤形态与跨导管大动脉置换 (TAVR) 后的急性结果有关.
- 严重的大动脉动脉瘤与长期TAVR结局之间的关联仍未得到充分研究.
研究的目的:
- 调查严重的大动脉动脉瘤对TAVR后长期结果的影响.
- 为了确定与TAVR后严重的大动脉动脉瘤相关的特定风险.
主要方法:
- 对977名接受TAVR的患者的回顾性分析,使用可用的对比度增强计算机断层扫描 (CECT) 数据.
- 严重的大动脉动脉瘤的定义:突出的动脉瘤≥3mm,性动脉瘤或动脉瘤≥5mm.
- 主要终点:2年主要不良心脏和脑血管事件 (MACCE),包括心血管死亡,心肌梗塞,缺血性中风和心力衰竭,分析在周围手术,早期和晚期阶段.
主要成果:
- 患有严重大动脉动脉瘤的患者 (28%) 呈现较高的2年MACCE的累积发病率 (40.6%对28.9%,p=0.0002).
- 在患有严重动脉瘤的患者中,观察到缺血性中风 (13.8% vs. 6.8%,p=0.0012) 和心血管死亡 (18.6% vs. 10.8%,p=0.0009) 的风险增加.
- 严重的大动脉动脉瘤是2年MACCE (aHR 1.49) 的独立风险因素,与周围手术性中风/死亡和晚期中风有关.
结论:
- 严重的大动脉动脉瘤是TAVR后2年MACCE增加的独立预测因素.
- 严重的大动脉动脉瘤的存在增加了早期和晚期不良事件的风险,包括中风和心血管死亡.
- 对大动脉动脉瘤的术前评估可能有助于对TAVR患者的风险分层.
相关概念视频
Aortic Regurgitation III: Medical Management
47
Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
47
Aortic Regurgitation I: Introduction
42
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...
42
Aneurysm II: Clinical Manifestations and Diagnostic Studies
25
Thoracic, aortic arch and abdominal aneurysms are significant vascular conditions that can present with various clinical manifestations and lead to serious complications. Understanding these manifestations and the appropriate diagnostic studies is essential for effective management and treatment.Thoracic Aortic AneurysmsThoracic aortic aneurysms often remain asymptomatic until they reach a size that impinges on adjacent structures. They typically cause deep, diffuse chest pain that radiates to...
25
Aortic 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
Aneurysm III: Interprofessional Care
29
Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
29
Atherosclerosis III: Management
40
Management of atherosclerosis involves an integrated strategy encompassing pharmacological treatment, surgical interventions, lifestyle changes, and nutrition therapy to address the multifactorial nature of the disease.Pharmacological TherapyA cornerstone of atherosclerosis management is the use of pharmacological agents. Statins, such as atorvastatin, are pivotal in inhibiting HMG-CoA reductase, an enzyme that catalyzes an initial step in cholesterol synthesis in the liver. This reduction in...
40

