JACC:球囊主动脉瓣成形术作为主动脉瓣置换的桥梁

2020-03-19 MedSci原创 MedSci原创

这项研究旨在使用一个国家代表性数据库来评估在当代临床实践中,球囊主动脉瓣成形术(BAV)作为经导管主动脉瓣置换术(TAVR)桥梁的发生率、预测指标和结局。目前关于BAV作为TAVR桥梁使用和结局的全国

这项研究旨在使用一个国家代表性数据库来评估在当代临床实践中,球囊主动脉瓣成形术(BAV)作为经导管主动脉瓣置换术(TAVR)桥梁的发生率、预测指标和结局。目前关于BAV作为TAVR桥梁使用和结局的全国性数据有限。

确定2015年1月至6月国家再入院数据库中进行过BAV的患者。研究人员评估了BAV之后的后续TAVR发生率,以及后续TAVR的预测因素和时间。然后,研究人员确定了2015年初至2016年国家再入院数据库数据集中直接接受TAVR(无先前BAV)的一组患者。比较了先接受桥接BAV患者与直接TAVR患者在TAVR后的住院结局。

纳入的3691名患者中,1426名(38.6%)随后进行了TAVR。TAVR的时间为:7.4%的患者在出院前进行,35%在出院后30天内,47%在出院后31至90天,14%在出院后91至180天,而4%在出院180天以后。后续TAVR的阴性预测指标包括既往有除颤器(比值比[OR]:0.56;95%置信区间[CI]:0.36-0.85)、痴呆(OR:0.60;95%CI:0.46-0.79)、营养不良(OR:0.64;95%CI:0.45-0.90)和恶性肿瘤(OR:0.62;95%CI:0.47-0.82)。在直接TAVR与先接受BAV的倾向评分匹配患者队列中,TAVR入院期间的院内死亡率相似(3.7%vs. 3.5%;p=0.91)。主要并发症、住院时间和出院情况也相当。但是,直接TAVR组的住院费用较高。

约40%的BAV患者随后进行TAVR,并且大部分在90天内进行。这些患者的TAVR院内结局与不进行BAV直接进行TAVR的倾向评分匹配患者相当。需要进一步的研究来确定BAV在当代临床实践中的作用。

原始出处:

Akram Kawsara. Balloon Aortic Valvuloplasty as a Bridge to Aortic Valve Replacement A Contemporary Nationwide Perspective. JACC:Cardiovascular Interventions. March 2020.

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    2020-04-07 hbwxf
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    2020-07-09 yxch48
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    2020-03-20 花花1366
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