门重新干预的决策:再导管主动脉置换与开口手术
Lior Lupu1, Pavan Reddy1, Dan Haberman1
1Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA.
概括
对于失效的TAVR门来说,选择再导管大动脉置换 (TAVR) 和外科扩张剂是复杂的. 手术扩容剂与较高的重大心脏不良事件 (MACE) 发生率有关,这表明每个方法的患者群体不同.
科学领域:
- 心血管医学
- 干预心脏病学
- 心脏外科
背景情况:
- 超导管大动脉置换 (TAVR) 是对大动脉狭窄的常见治疗方法.
- 对于TAVR门故障的指导因素的数据是有限的.
- 对于患者的治疗结果来说,了解回复TAVR和外科扩展剂之间的治疗选择至关重要.
研究的目的:
- 为了确定临床和程序因素影响的选择之间的重复TAVR和手术扩展剂的失败TAVR.
- 在需要主动脉再干预的患者中,比较重复TAVR与外科实验的结果.
主要方法:
- 在先前的TAVR (2015年1月至2024年6月) 后接受主动脉再干预的患者的单中心,回顾性研究.
- 审查临床记录,成像和心脏团队的笔记,以确定治疗的合理性.
- 收集程序细节和主要心脏不良事件 (MACE:死亡,再住院,中风).
主要成果:
- 在47名患者中,有24名患者 (51%) 接受了手术,23名患者 (49%) 接受了再处理TAVR.
- 经过手术的患者年龄较小 (75岁与79岁),并且30天 (30. 4%与0%) 和1年 (59. 1%与21. 4%) 的MACE率较高.
- 解释剂的指示包括内心炎,患者假肢不匹配,以及环状破裂或冠状动脉阻塞的风险.
结论:
- 对失败的TAVR的治疗均地分为重复TAVR和外科扩张剂,突出显示了终身门规划的需要.
- 这两种方法服务于具有不同并发症和程序复杂性的不同患者群体.
- 需要随机试验来确定TAVR再干预的最佳治疗途径.
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