JACC: CoreValve研究——高危患者TAVR或SAVR术后5年结局竟相似

2018-12-09 国际循环编辑部 国际循环

近日,JACC发表了CoreValve美国核心高风险试验5年随访结果,这是第一项在手术高死亡风险患者中显示,经导管主动脉瓣置换术(TAVR)与外科主动脉瓣置换术(SAVR)相比,具有1年死亡率优势的随机试验。

近日,JACC发表了CoreValve美国核心高风险试验5年随访结果,这是第一项在手术高死亡风险患者中显示,经导管主动脉瓣置换术(TAVR)与外科主动脉瓣置换术(SAVR)相比,具有1年死亡率优势的随机试验。



研究者将TAVR与SAVR进行比较,以获得安全性、性能和耐用性的5年中期结果。将外科高危患者按1:1随机分配至TAVR自膨胀生物瓣膜组或SAVR组。应用VARC-1(Valve Academic Research Consortium I)定义。重度血流动力学结构瓣膜恶化被定义为平均梯度压≥40 mm Hg或梯度≥20 mm Hg的变化或新发重度主动脉瓣关闭不全。计划进行为期5年随访。

结果显示,共随机纳入美国45个中心的797例患者,其中750例患者尝试进行瓣膜植入(TAVR=391,SAVR=359)。总体平均年龄为83岁,STS评分为7.4%。5年时全因死亡率TAVR组为55.3%,SAVR组为55.4%。亚组分析显示,两组死亡率无显著统计学差异。卒中发病率TAVR组为12.3%,SAVR组为13.2%。平均主动脉瓣梯度压TAVR组为(7.1±3.6)mm Hg,SAVR组为(10.9±5.7)mm Hg。未观察到临床显著瓣膜血栓形成。无重度结构性瓣膜退化(SVD)TAVR组为99.2%和SAVR组为98.3%(P=0.32),无需瓣膜再介入TAVR组为97.0%,SAVR组为98.9%(P=0.04)。5年时,患者永久起搏器植入率TAVR组为33.0%和SAVR组为19.8%。

研究提示,TAVR或SAVR术后高危患者的中期生存率和卒中发生率相似。重度结构性瓣膜恶化和瓣膜再次介入并不常见。

原始出处:
Thomas G. Gleason, Michael J. Reardon, Jeffrey J. Popma, et al. 5-Year Outcomes of Self-Expanding Transcatheter Versus Surgical Aortic Valve Replacement in High-Risk Patients. JACC. Volume 72, Issue 22, December 2018.

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    2019-07-17 hbwxf
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  6. [GetPortalCommentsPageByObjectIdResponse(id=1991694, encodeId=d25e1991694bb, content=<a href='/topic/show?id=bcb35099cb' target=_blank style='color:#2F92EE;'>#CoreValve#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5099, encryptionId=bcb35099cb, topicName=CoreValve)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=49ef408, createdName=hunizi005, createdTime=Sun Jan 27 17:05:00 CST 2019, time=2019-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2086347, encodeId=43e6208634e63, content=<a href='/topic/show?id=134b304456' target=_blank style='color:#2F92EE;'>#AVR#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3044, encryptionId=134b304456, topicName=AVR)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7d74253, createdName=wangtianj2007@, createdTime=Sat Apr 27 08:05:00 CST 2019, time=2019-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1854248, encodeId=19cc1854248bc, content=<a href='/topic/show?id=48351020537' target=_blank style='color:#2F92EE;'>#JACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10205, encryptionId=48351020537, topicName=JACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Wed Jul 17 22:05:00 CST 2019, time=2019-07-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1796685, encodeId=d3201e96685e4, content=<a href='/topic/show?id=e08d182e056' target=_blank style='color:#2F92EE;'>#valve#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=18270, encryptionId=e08d182e056, topicName=valve)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=09a12500213, createdName=12498f1em08(暂无昵称), createdTime=Thu Nov 14 13:05:00 CST 2019, time=2019-11-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1955771, encodeId=151b1955e71a9, content=<a href='/topic/show?id=5b0b1022667b' target=_blank style='color:#2F92EE;'>#高危患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102266, encryptionId=5b0b1022667b, topicName=高危患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=05a2499, createdName=dzx0922889, createdTime=Sat Jul 20 00:05:00 CST 2019, time=2019-07-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1326061, encodeId=969f132606144, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Tue Dec 11 10:05:00 CST 2018, time=2018-12-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1531292, encodeId=bf7b153129274, content=<a href='/topic/show?id=f748159211d' target=_blank style='color:#2F92EE;'>#SAVR#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=15921, encryptionId=f748159211d, topicName=SAVR)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=713e12248174, createdName=Smile2684, createdTime=Tue Dec 11 10:05:00 CST 2018, time=2018-12-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1561996, encodeId=cd02156199685, content=<a href='/topic/show?id=309f509e9a' target=_blank style='color:#2F92EE;'>#CORE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5097, encryptionId=309f509e9a, topicName=CORE)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=docwu2019, createdTime=Tue Dec 11 10:05:00 CST 2018, time=2018-12-11, status=1, ipAttribution=)]
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    2018-12-11 Smile2684
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    2018-12-11 docwu2019

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Circ: Cardiovascular Interventions:左束支传导阻滞对经导管主动脉瓣置换术的影响

先前存在LBBB显著增加TAVR后早期PPI的风险(而不是晚期),对总体死亡率或心血管死亡率没有任何显著影响。

JACC:老年人经导管主动脉瓣置换术中虚弱与穿刺部位的相互作用

虚弱患者接受更具侵入性的非股动脉通路TAVR后的30天死亡率风险明显升高。而无论通路如何,非虚弱老年人都能耐受TAVR,并且短期风险低。

JACC:基于医院TAVR手术量的单纯外科主动脉瓣置换术趋势

在TAVRs手术量最大的医院,TAVR的出现与单纯SAVR手术量减少、SAVR患者并发症减少和长短期SAVR死亡率的相应降低相关。

JACC:既往心脏手术患者经导管与外科主动脉瓣置换术的比较

伴或不伴PCS患者接受TAVR和SAVR的2年不良临床结局的相对风险是相似的。

Circ: Cardiovascular Interventions:经导管主动脉瓣置换术中经颈动脉与其他替代通路的比较

经颈动脉血管通路的TAVR安全可行,并与令人满意的短期临床结局相关。