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在7岁的低风险患者中进行透导管或外科动脉置换

Martin B Leon^1,2, Michael J Mack³, Philippe Pibarot⁴

¹Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York.

The New England journal of medicine

|October 27, 2025

概括

过导管大动脉置换 (TAVR) 和手术大动脉置换在患有严重大动脉狭窄症的低风险患者中显示出类似的7年结果. 这两种手术的死亡,中风和再住院率都相当,支持TAVR作为可行的选择.

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:

在PARTNER 3试验之前,在患有严重症状性大动脉狭窄症的低风险患者中,过导管大动脉置换 (TAVR) 和手术大动脉置换 (SAVR) 的5年结果相似.
长期数据对于评估临床结果和通过TAVR与SAVR植入门的耐用性至关重要.

研究的目的:

为了比较TAVR和SAVR之间的7年临床结果和门耐用性,在患有严重,症状性大动脉狭窄的低风险患者中.

主要方法:

这是一项随机对照试验,涉及1000名患有严重,症状性大动脉狭窄症的低风险患者,分别以1:1的比例分配给输血性TAVR或SAVR.
主要终点包括死亡,中风或再住院的复合物,以及通过胜率分析的等级复合物.
临床,心声学,门耐用性和患者报告的结果在术后长达7年的时间内进行了评估.

主要成果:

7年后,第一个主要复合终点 (死亡,中风,再住院) 的发生率为TAVR的34.6%,SAVR的37.2% (差异:-2.6个百分点).
对第二个主要终点的胜利比率分析显示,TAVR和SAVR之间没有显著差异.
死亡率,中风和再住院率在各组之间是可比的;生物假体门故障发生在6.9%的TAVR门和7.3%的SAVR门中. 患者报告的结果也相似.

结论:

在患有严重的症状性大动脉狭窄症的低风险患者中,TAVR和SAVR在7年复合终点死亡,中风和再住院方面没有显著差异.
这些发现表明,TAVR是这种患者群体在更长的随访期内治疗手术的持久和有效替代方案.

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