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在心脏移植手术后进行手术和透气管大动脉置换:一系列病例

Luise Roehrich^1,2,3, Hristian Hinkov^4,5,6,7, Christoph Knosalla^4,5,6

¹Deutsches Herzzentrum der Charité (DHZC), Department of Cardiothoracic and Vascular Surgery, Augustenburger Platz 1, Berlin, Germany. luise.roehrich@dhzc-charite.de.

Communications medicine

|October 1, 2025

概括

心脏移植后的大动脉功能障碍是罕见的. 手术 (SAVR) 和透导管 (TAVR) 门置换都是可行的,对于符合条件的患者来说,TAVR越来越受青.

科学领域:

心脏病学心脏病学
心脏外科手术心脏外科手术
移植医学移植医学

背景情况:

大动脉功能障碍是一种罕见但显著的长期并发症,发生在心脏移植 (HTX) 之后.
目前的治疗策略,包括手术性大动脉置换 (SAVR) 和透气管大动脉置换 (TAVR),缺乏广泛的证据,主要依赖病例报告.

研究的目的:

评估先前接受过心脏移植的患者的大动脉置换手术的结果.
在这个特定的高风险患者群体中比较SAVR和TAVR的有效性和可行性.

主要方法:

在1986年至2023年间,在HTX后接受了大动脉置换 (7 SAVR, 9 TAVR) 的16名患者的回顾性病例系列分析.
收集的数据包括患者人口统计数据,手术前的情况,手术细节和手术后的结果.

主要成果:

大动脉狭窄的发生率比吐 (31%) 高 (69%).
在手术前的严重心力衰竭在38%的患者中被发现.
三十天死亡率为0%,住院死亡率为22% (两名败血症患者,两人都在TAVR前严重失补偿).
50%的患者经历了无事件的术后过程,75%的患者表现出改善的功能状态.

结论:

透导管大动脉置换 (TAVR) 正在成为心脏移植后大动脉功能障碍的首选治疗方法.
手术性大动脉置换 (SAVR) 对于不适合TAVR的患者来说仍然是一个可行的替代方案.
需要进一步的研究来确定这些高风险个体的最佳程序时间.

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