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永久性心脏起器植入的预测因素在拉菲型双动脉狭窄症患者中,接受TAVR治疗
Antonio Mangieri1, Mauro Gitto2, Giuseppe Tarantini3
1IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy.
The American journal of cardiology
|September 29, 2025
概括
在拉菲型双主动脉 (BAV) 狭窄症中,经过透气管大动脉置换 (TAVR) 后的永久心脏起器植入 (PPI) 在15.5%的患者中发生. 这种PPI不会影响中期临床结果,尽管某些患者因素预测了它的必要性.
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:
- 关于永久心脏起器植入 (PPI) 的预测因子和结果的数据有限,这些患者患有拉菲型双主动脉 (BAV) 狭窄症,接受过导管主动脉置换 (TAVR).
- 了解这些因素对于优化TAVR程序和患者管理至关重要.
研究的目的:
- 评估PPI的发病率,预测因子和临床影响,用TAVR治疗拉菲型BAV狭窄症患者.
- 确定与PPI相关的特定患者特征和程序元素.
主要方法:
- 国际AD-HOC注册表收集了912名RAPHE型BAV狭窄症患者的数据,这些患者在2016年至2023年期间接受了TAVR.
- 多变量后勤回归分析了PPI的临床,解剖和程序预测因素.
- 评估了PPI对整体存活率和门学术研究联盟-3 (VARC-3) 临床疗效终点的影响.
主要成果:
- 在141名患者 (15.5%) 中需要PPI,在PPI和非PPI组之间VARC-3技术或设备成功没有显著差异.
- PPI的独立预测因素包括外周血管疾病,慢性病,手术前的右捆分支阻断 (RBBB),R-L raphe局部化,以及使用Evolut R/Pro/Pro+门.
- 在3年的随访中,VARC-3临床疗效终点 (免于死亡,心力衰竭住院或TIA/中风) 在两组中都相似.
结论:
- 在BAV狭窄症中,TAVR后的PPI相对比较常见,但不会对中期临床结果产生不利影响.
- 独特的解剖学预测因子,如R-L raphe定位,以及手术前的RBBB和特定的门类型,与该人群中的PPI有关.
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