跨导管大动脉置换后永久心脏起器植入的外科手术风险因素:系统性审查和元分析
Xi Peng1,2, Nan Chen1, Peng Li3
1Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, 100730 Beijing, China.
Reviews in cardiovascular medicine
|November 10, 2025
概括
这一元分析确定了经过过导管大动脉置换 (TAVR) 后永久起器 (PPM) 植入的关键预测因素. 右捆分支阻塞和植入深度增加增加了PPM风险,而尖端重叠技术减少了PPM风险.
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:
- 透导管大动脉置换 (TAVR) 是严重大动脉狭窄的主要治疗方法,特别是在高风险的手术患者中.
- 永久心脏起器 (PPM) 植入是TAVR手术后的常见并发症.
- 确定PPM的术后预测因子对于患者管理至关重要.
研究的目的:
- 在TAVR后30天内进行系统审查和元分析,以确定PPM植入的术后预测因素.
- 综合多项研究的证据,提供风险和保护因素的全面概述.
主要方法:
- 在PubMed,Web of Science和Embase进行了系统的文献搜索.
- 分析了82项涉及124,808名患者的研究数据.
- 使用随机效应模型计算了95%置信区间 (CI) 的聚合几率比率 (OR).
主要成果:
- 在TAVR后30天内,PPM植入的总发病率为17.5%.
- 对于PPM植入的关键预测因素包括右束枝阻塞 (RBBB),一级心房阻塞 (AVB),更大的植入深度,使用自膨胀,气球预拉.
- 凸骨重叠技术 (COT) 和膜隔膜长度和植入深度 (ΔMSID) 的较小差异与减少PPM风险有关.
结论:
- 这一元分析突出了影响PPM植入后TAVR的显著外科手术预测因素.
- 诸如RBBB,AVB,植入深度增加,自扩张门和预扩张等因素增加了PPM风险.
- 鉴定出COT和较低的ΔMSID是防止PPM植入的保护因素.
相关概念视频
Aneurysm IV: Nursing Management
364
Vigilant monitoring for aneurysm rupture is essential for patients undergoing aortic surgery.Preoperative Nursing ManagementContinuously monitor the patient for manifestations of aneurysm rupture, such as pallor, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain, changes in consciousness, and a pulsating abdominal mass. Regularly assess the patient's peripheral pulses.Instruct the patient to consume a clear liquid diet the day before surgery and administer...
364
Cardiomyopathy VII: Pre and Post Operative Nursing Management
268
Patients with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract (LVOT) obstruction who remain symptomatic despite optimal medical therapy may undergo a septal myectomy (Morrow procedure). This procedure involves excising a portion of the hypertrophied septum below the aortic valve using a heart-lung machine to improve blood flow through the LVOT. Effective preoperative and postoperative nursing management ensures successful patient outcomes, minimizes complications, and...
268
Aortic Regurgitation III: Medical Management
383
Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
383


