JAHA:经导管主动脉瓣置换术后快速心室起搏对预后的影响

2018-07-13 xiangting MedSci原创

在接受TAVR的患者中,多次RVP和RVP持续时间延长与预后不良相关,其中包括短期和长期死亡率。

通常在经导管主动脉瓣置换术(TAVR)中使用快速心室起搏(RVP)。然而关于这一操作的安全性和临床结局知之甚少。这项研究目的是评估在一个大型非选择性TAVR患者队列中RVP对短期和长期临床预后的影响。

这项研究纳入412例接受TAVR的连续性患者,平均年龄为82±7岁,其中47%为男性。根据TAVR手术期间RVPs的数量对患者进行分组,未起搏患者(0)、1-2次起搏和≥3次起搏(3+)。3+以上起搏患者的新发房颤(0、1-2和3+组分别为5.6% vs 7.3% vs 15%,P=0.047),急性肾损伤(AKI) 的可能性显著升高(分别为18% vs 18% vs 28%,P<0.001),术后低血压时间延长(分别为0%、16%和25%;P<0.001),院内死亡率(分别为1.7%、1.7%和6.5%,P=0.045)和1年死亡率较高(分别为11.1%、7.7%和18%,P=0.015)。多因素Cox回归分析显示急性肾损伤(OR 3.27 [1.763-6.09],P<0.001),euroSCORE II(每单位OR 1.06 [1.01-1.12],P=0.03)和3+以上起搏(OR 2.35 [1.18-4.7],P=0.02)是1年死亡率的仅有独立预测因子。

在接受TAVR的患者中,多次RVP和RVP持续时间延长与预后不良相关,其中包括短期和长期死亡率。因此,术者应尽量减少RVP的使用,尤其是对有术后急性肾损伤风险的患者。

原始出处:

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    2019-06-02 yxch48
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    2018-07-15 zhaohui6731
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    2018-07-15 lsj631
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