Circulation: 介入治疗二叶式主动脉瓣狭窄的效果与三叶式瓣膜相当

2020-02-28 朱朱 中国循环杂志

二叶式主动脉瓣由于其特殊的解剖结构及力学表现,尤其是0型二叶瓣,行经导管主动脉瓣置换(TAVR)术易发生瓣周漏、瓣膜移位、主动脉夹层等并发证,其手术难度和风险均高于三叶式主动脉瓣。

二叶式主动脉瓣由于其特殊的解剖结构及力学表现,尤其是0型二叶瓣,行经导管主动脉瓣置换(TAVR)术易发生瓣周漏、瓣膜移位、主动脉夹层等并发证,其手术难度和风险均高于三叶式主动脉瓣。

随着TAVR治疗二叶式主动脉瓣狭窄的使用日益增多,越来越多的学者关注其临床结局。
 
2月26日,美国胸外科医师学会(STS)/美国心脏病学会(ACC)经导管瓣膜治疗注册研究发布的最新报告表明,应用目前最新的器械,接受TAVR治疗的二叶式主动脉瓣狭窄患者的术中、术后、1年预后与三叶式主动脉瓣狭窄患者相当。
 
研究者表示,随着新器械的研发上市,TAVR治疗二叶式主动脉瓣狭窄切实可行。
 
该研究显示,与应用老一代器械相比,在应用目前最新器械为二叶式主动脉瓣狭窄患者进行TAVR治疗时,器械成功率增加(93.5% vs 96.3%),二度以上主动脉瓣反流发生率(14.0% vs 2.7%)明显降低。
 
应用目前最新器械的情况下,与三叶式主动脉瓣狭窄患者相比,二叶式主动脉瓣狭窄患者中器械成功率略微降低(96.3% vs 97.4%),残余中度或重度主动脉瓣关闭不全略高(2.7% vs 2.1%)。
 
在医保患者中,1年时,二叶式主动脉瓣狭窄患者的校正后死亡风险比三叶式主动脉瓣狭窄患者降低了12%,但中风风险无显著差异。
 
该研究利用2011年11月至2018年11月的数据,共涉及近17.1万例TAVR手术,其中二叶式主动脉瓣狭窄患者占3.2%。
 
与三叶式主动脉瓣狭窄患者相比,二叶式主动脉瓣狭窄患者相对年轻,STS外科手术风险评分较低。
 
原始出处:
Sharif A. Halim , et al. Outcomes of Transcatheter Aortic Valve Replacement in Patients with Bicuspid Aortic Valve Disease: A Report from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. Circulation, Originally published 26 Feb 2020

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    学习

    0

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    2020-02-28 CHANGE

    疗效只是效果的众多方面之一,还要看对患者的获益,包括生活质量等因素共同决定效果的

    0

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