在 Valve-in-Valve Transcatheter 大动脉植入后出现了道错位
Matthias Raschpichler1, Johannes Rotta Detto Loria2, Vivek Patel3
1University Hospital of Cardiac Surgery, Heart Center Leipzig at Leipzig University, Leipzig, Germany.
概括
由于冠状动脉阻塞,在失败的外科动脉置换 (SAVR) 过程中,在门中门跨导管大动脉植入 (ViV-TAVI) 过程中出现了门错位 (CMA),从而减少了技术上的成功. 然而,中期生存率仍然不受CMA的影响.
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:
- 在门内透导管大动脉植入 (ViV-TAVI) 失败的外科大动脉置换 (SAVR) 中,关于大动脉错位 (CMA) 的数据有限.
- 了解CMA的影响对于优化ViV-TAVI程序至关重要.
研究的目的:
- 为了研究CMA对ViV-TAVI后临床和血液动力学结果的影响,在以前有SAVR的患者中.
- 在ViV-TAVI期间识别与CMA相关的特定并发症.
主要方法:
- 在两个机构对180名因失败的SAVR接受ViV-TAVI的患者进行了回顾性分析.
- 使用术后计算机断层扫描 (CT) 评估CMA.
- 门学术研究联盟 (VARC) 的评估-3临床终点,低衰减叶片加厚 (HALT),血液动力学和死亡率.
主要成果:
- 在19.4%的患者中,出现了圆周错位 (CMA).
- CMA与技术成功显著降低相关 (80%与93%,p=0.03),主要是由于冠状动脉阻塞增加 (17.1%与5.6%,p=0.03).
- 低衰减叶片加厚 (HALT) 和装置成功率在各组之间相似;中期存活率相似 (84.6%).
结论:
- 对于失败的SAVR,ViV-TAVI期间的Commissural misalignment (CMA) 与较低的技术成功率有关.
- 冠状动脉阻塞的风险增加是CMA病例成功减少的主要驱动因素.
- 尽管存在程序上的挑战,但CMA似乎不会影响中期生存率.
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