年轻人穿过导管的大动脉植入:转移风险和结果
J Hunter Mehaffey1, Vikrant Jagadeesan2, Michael Bowdish3
1Department of Cardiovascular and Thoracic Surgery, West Virginia University.
概括
接受过导管大动脉植入术 (TAVI) 的年轻患者 (≤65岁) 通常具有较低的手术风险. 对这些患者来说,仔细的心脏团队评估对于这些患者来说至关重要,考虑到TAVI.
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
- 医疗保健服务研究 医疗服务研究
背景情况:
- 透气管大动脉植入 (TAVI) 越来越多地用于65岁及以下的患者.
- 这些年轻的患者往往被认为具有高手术风险,预期寿命有限.
研究的目的:
- 为了评估预测的风险,程序结果,纵向结果和65岁或更年轻的患者TAVI的成本.
- 在这个人口群体中基于预测的死亡风险对TAVI结果进行分层.
主要方法:
- 对6,921名年龄在65岁或以下的患者进行分析,这些患者在2017年至2024年期间接受了TAVI.
- 利用模拟的胸部外科医生协会风险模型,结合Fried脆弱指数来评估预测的死亡风险 (AUC=0.850).
主要成果:
- 平均年龄为60岁,81.3%的手术是可选的,9.1%涉及双主动脉.
- 平均预测死亡风险为4.3%,其中66.2%的患者的预测风险低于4%.
- 30天死亡率为0.7%,显著的并发症率包括中风 (1.0%) 和新的永久起器 (4.1%). 低/中等风险患者的5年生存率为88%,高风险患者为78%.
结论:
- 大多数65岁或更年轻的当代患者在当前指导方针之外接受TAVI治疗,手术风险较低.
- 这些发现强调了对接受大动脉置换 (AVR) 的年轻患者进行彻底的心脏团队讨论的必要性,考虑到TAVI的累积风险.
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