气球可扩展与自扩展在左心室缩性功能障碍患者的跨导管大动脉置换中的气球可扩展与自扩展
Berhan Keskin1, Aykun Hakgör1, Atakan Dursun1
1Department of Cardiology, Istanbul Medipol University, Medipol Mega University Hospital, Istanbul, Türkiye.
概括
通过气球可扩展 (BEV) 或自扩展 (SEV) 进行过导管大动脉置换 (TAVR) 在患有严重大动脉狭窄和左心室缩功能障碍的患者中显示出类似的长期存活率. 门类型没有影响这个高风险组的结果.
科学领域:
- 心血管医学 心血管医学
- 干预心脏病学 干预心脏病学
- 心脏门疾病 心脏门疾病
背景情况:
- 严重的大动脉狭窄 (AS) 与左心室缩功能障碍 (LVSD) 是一个脆弱的亚组,经历过透气管大动脉置换 (TAVR).
- 在这个特定群体中,气球扩展 (BEV) 和自扩展 (SEV) 的比较结果数据有限.
研究的目的:
- 在接受TAVR的严重AS和LVSD患者中,比较BEV与SEV的程序和长期结果.
- 在这个高风险患者队列中确定长期死亡率的预测因素.
主要方法:
- 在246名连续患者的回顾性单中心研究中,左心室喷射分数 (LVEF) <50%,接受了TAVR输血.
- 在BEV (n=96) 和SEV (n=150) 接受者之间的临床,心声和程序特征的比较.
- 主要终点是长期全因死亡率,使用卡普兰-梅尔曲线和多变量考克斯回归分析.
主要成果:
- 与BEV相比,SEV植入导致了较低的术后跨膜梯度 (7.8 ± 4.0 mmHg与9.6 ± 4.1 mmHg相比,P=0.001).
- 在BEV组中,原始死亡率较高 (50.0%与36.0%,P=0.041),但Kaplan-Meier存活率分析显示长期存活率没有显著差异 (日志排名P=0.92).
- 多变量分析确定了老年,COPD,冠状动脉疾病,较低的血清白蛋白和较低的血红蛋白作为死亡率的预测因素;门类型不是一个重要的预测因素.
结论:
- 在接受TAVR的LVSD患者中,BEV和SEV的过程和长期结果相似.
- 虽然SEV可能导致术后梯度较低,但门选择在本研究中没有影响生存率.
- 需要对更大的队列和下一代设备进行进一步的研究,以优化这种脆弱的患者群体的门选择.
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