挑战跨导管-第一范式:在之前的跨导管或外科动脉置换后重新切换动脉
Shinichi Fukuhara1, Carol Ling1, Himanshu J Patel1
1Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA.
The Journal of thoracic and cardiovascular surgery
|August 21, 2025
概括
经过透气管的大动脉置换后的手术大动脉置换 (TAVR-SAVR) 显示出比重复手术大动脉置换 (SAVR-SAVR) 更高的手术死亡率. 对于需要长期保持门功能的患者,TAVR-SAVR策略需要重新考虑.
科学领域:
- 心血管外科
- 干预心脏病学
- 心脏膜疾病
背景情况:
- 大动脉替换 (TAVR) 后的大动脉重复手术的发生率正在增加.
- 高患者异质性对TAVR-SAVR结果的比较分析有限.
- 有关TAVR-SAVR程序的临床结果存在担忧.
研究的目的:
- 在TAVR (TAVR-SAVR) 和重复SAVR (SAVR-SAVR) 后进行大动脉置换手术 (SAVR) 的临床结果进行比较.
- 分析主动脉重复手术的趋势.
- 评估不同主动脉重置手术的安全性和有效性.
主要方法:
- 在2011年至2024年期间,确定了一组1024名患者接受TAVR或SAVR后的SAVR.
- 这些患者接受了隔离SAVR±冠状动脉旁路移植 (CABG).
- 使用倾向分数匹配来比较TAVR-SAVR和SAVR-SAVR组之间的结果.
主要成果:
- 到2024年,TAVR-SAVR在主动脉重复手术中的比例增加到31. 3%.
- TAVR-SAVR患者年龄较大,并具有较高的并发症和更大的心力衰竭负担.
- 即使在倾向性得分匹配后,TAVR-SAVR也显示了显著更高的手术死亡率 (12. 3% 与 1. 1% 相比,p< 0. 001).
结论:
- TAVR-SAVR病例正在增加,到2029年可能超过SAVR-SAVR.
- SAVR-SAVR策略被证明是极其安全的,观察到的死亡率与预期的死亡率很低.
- 需要重新考虑TAVR-first策略,特别是对于可能超过TAVR假肢耐用性的患者.
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