传染性内心炎和心脏事件经过透导管 vs 外科动脉置换 - 一个全国性的队列研究
Alexander Kutz1, Martin Purtak2, Rahel Laager3
1Department of General Internal and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
概括
通过导管的大动脉植入 (TAVI) 和生物假肢手术大动脉置换 (SAVR) 与机械SAVR相比,感染性内心炎 (IE) 的发生率更高. 这些发现凸显了与不同的大动脉置换策略相关的风险.
科学领域:
- 心脏病学 心脏病学
- 心脏外科手术 心脏外科手术
- 传染性疾病 传染性疾病
背景情况:
- 大动脉狭窄是一种常见的膜性心脏病.
- 手术性大动脉置换 (SAVR) 和透气管大动脉植入 (TAVI) 是主要的治疗选择.
- 假内心炎 (PVE) 是门置换后的一种严重并发症.
研究的目的:
- 为了比较感染性内心炎 (IE) 和主要心脏不良事件 (MACE) 在接受TAVI,生物假体SAVR (bioSAVR) 和机械SAVR (mechSAVR) 的患者中的发生率.
- 评估不同大动脉置换策略的比较安全性和有效性.
主要方法:
- 瑞士 (2012-2021) 基于人口的队列研究,包括接受TAVI,生物SAVR或mechSAVR的成年住院患者.
- 分析了两对1:1倾向分数匹配的队列:TAVI与生物SAVR和生物SAVR与mechSAVR.
- 主要结局是IE的发生率;次要结局包括MACE.
主要成果:
- 总共包括了18,253名患者 (平均年龄为76.6岁).
- 在所有组中,干预后的前三个月IE发病率最高.
- 在TAVI与生物SAVR (HR 1.56) 和生物SAVR与机械SAVR (HR 2.27) 中,IE率显著更高. 对于TAVI与生物SAVR和生物SAVR与机械SAVR的MACE率也较高.
结论:
- 与生物SAVR相比,TAVI与更高的IE率有关.
- 与mechSAVR相比,生物SAVR与更高的IE率有关.
- 与机械SAVR相比,TAVI和生物SAVR都带有IE和MACE的风险增加.
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