JACC:新型自扩张与球囊扩张型经导管心脏瓣膜的多中心比较

2017-10-17 xiangting MedSci原创

两种瓣膜的成功率都非常高,临床和手术结果相当。

这项研究在设备故障和30天的早期安全性方面,比较了2种下一代经导管心脏瓣膜(THV):自扩张型ACURATE neo(NEO)和球囊扩张型SAPIEN 3(S3)。

这些THV使用的初步临床结果是有前途的。但是没有比较性的数据。

在3个中心治疗的1,121例患者中,进行1对2最邻近匹配,每1例接受NEO治疗的患者(n = 311)匹配3例S3(n = 622)治疗的患者。

NEO和S3的院内并发症相似,包括中风(1.9%vs. 2.4%; p = 0.64),大血管并发症(10.3%vs. 8.5%; p = 0.38)或危及生命的出血(4.2%vs. 3.7%; p = 0.72)。NEO的设备故障与S3相似(10.9%vs. 9.6%;优势比:1.09 [95%置信区间:0.69-1.73]; p = 0.71),NEO瓣旁渗漏更多(PVL II +,4.8%vs.1.8%; p=0.01),但梯度升高(≥20mm Hg,3.2%vs. 6.9%; p = 0.02)和起搏器植入较少(9.9%vs.15.5%; p = 0.02)。NEO和S3的30天死亡率(2.3%vs. 1.9%; p = 0.74)和早期安全性复合终点(15.8%vs.15.6%;风险比:0.97 [95%置信区间:0.68至1.39]; p = 0.88)类似。

两种瓣膜的成功率都非常高,临床和手术结果相当。与S3相比,NEO与新起搏器植入和梯度升高较少相关,但瓣旁渗漏更多。

原始出处:
Oliver Husser, et al. Multicenter Comparison of Novel Self-Expanding Versus Balloon-Expandable Transcatheter Heart Valves. JACC: Cardiovascular Interventions. October 2017. 

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    2017-10-20 仁心济世
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2017, time=2017-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1510092, encodeId=3b391510092fd, content=<a href='/topic/show?id=e9bce8254ef' target=_blank style='color:#2F92EE;'>#经导管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78254, encryptionId=e9bce8254ef, topicName=经导管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=93e010191378, createdName=lsj631, createdTime=Thu Oct 19 07:58:00 CST 2017, time=2017-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1583533, encodeId=092a1583533fe, content=<a href='/topic/show?id=508d68e698c' target=_blank style='color:#2F92EE;'>#瓣膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=68769, encryptionId=508d68e698c, topicName=瓣膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=58dc16986228, createdName=12498e5fm17(暂无昵称), createdTime=Thu Oct 19 07:58:00 CST 2017, time=2017-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=253779, encodeId=0789253e795e, content=学习了.谢谢., beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Tue Oct 17 19:31:30 CST 2017, time=2017-10-17, status=1, ipAttribution=)]
  5. 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2017, time=2017-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1510092, encodeId=3b391510092fd, content=<a href='/topic/show?id=e9bce8254ef' target=_blank style='color:#2F92EE;'>#经导管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78254, encryptionId=e9bce8254ef, topicName=经导管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=93e010191378, createdName=lsj631, createdTime=Thu Oct 19 07:58:00 CST 2017, time=2017-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1583533, encodeId=092a1583533fe, content=<a href='/topic/show?id=508d68e698c' target=_blank style='color:#2F92EE;'>#瓣膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=68769, encryptionId=508d68e698c, topicName=瓣膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=58dc16986228, createdName=12498e5fm17(暂无昵称), createdTime=Thu Oct 19 07:58:00 CST 2017, time=2017-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=253779, encodeId=0789253e795e, content=学习了.谢谢., beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Tue Oct 17 19:31:30 CST 2017, time=2017-10-17, status=1, ipAttribution=)]
    2018-02-11 lsj637
  6. 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  7. 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2017, time=2017-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1510092, encodeId=3b391510092fd, content=<a href='/topic/show?id=e9bce8254ef' target=_blank style='color:#2F92EE;'>#经导管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78254, encryptionId=e9bce8254ef, topicName=经导管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=93e010191378, createdName=lsj631, createdTime=Thu Oct 19 07:58:00 CST 2017, time=2017-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1583533, encodeId=092a1583533fe, content=<a href='/topic/show?id=508d68e698c' target=_blank style='color:#2F92EE;'>#瓣膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=68769, encryptionId=508d68e698c, topicName=瓣膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=58dc16986228, createdName=12498e5fm17(暂无昵称), createdTime=Thu Oct 19 07:58:00 CST 2017, time=2017-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=253779, encodeId=0789253e795e, content=学习了.谢谢., beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Tue Oct 17 19:31:30 CST 2017, time=2017-10-17, status=1, ipAttribution=)]
    2017-10-19 花花1366
  8. 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2017, time=2017-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1510092, encodeId=3b391510092fd, content=<a href='/topic/show?id=e9bce8254ef' target=_blank style='color:#2F92EE;'>#经导管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78254, encryptionId=e9bce8254ef, topicName=经导管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=93e010191378, createdName=lsj631, createdTime=Thu Oct 19 07:58:00 CST 2017, time=2017-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1583533, encodeId=092a1583533fe, content=<a href='/topic/show?id=508d68e698c' target=_blank style='color:#2F92EE;'>#瓣膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=68769, encryptionId=508d68e698c, topicName=瓣膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=58dc16986228, createdName=12498e5fm17(暂无昵称), createdTime=Thu Oct 19 07:58:00 CST 2017, time=2017-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=253779, encodeId=0789253e795e, content=学习了.谢谢., beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Tue Oct 17 19:31:30 CST 2017, time=2017-10-17, status=1, ipAttribution=)]
    2017-10-19 lsj631
  9. 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  10. 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2017, time=2017-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1510092, encodeId=3b391510092fd, content=<a href='/topic/show?id=e9bce8254ef' target=_blank style='color:#2F92EE;'>#经导管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78254, encryptionId=e9bce8254ef, topicName=经导管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=93e010191378, createdName=lsj631, createdTime=Thu Oct 19 07:58:00 CST 2017, time=2017-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1583533, encodeId=092a1583533fe, content=<a href='/topic/show?id=508d68e698c' target=_blank style='color:#2F92EE;'>#瓣膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=68769, encryptionId=508d68e698c, topicName=瓣膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=58dc16986228, createdName=12498e5fm17(暂无昵称), createdTime=Thu Oct 19 07:58:00 CST 2017, time=2017-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=253779, encodeId=0789253e795e, content=学习了.谢谢., beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Tue Oct 17 19:31:30 CST 2017, time=2017-10-17, status=1, ipAttribution=)]
    2017-10-17 惠映实验室

    学习了.谢谢.

    0

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主动脉ViV手术后的冠脉阻塞是一种危及生命的并发症,在先前无支架或外部小叶支架生物假体及短VTC的患者中更为常见。

JACC:Portico导管主动脉生物假体家族所有4个瓣膜尺寸的植入和30天随访

在所有瓣膜尺寸中,使用可重新定位的Portico经导管主动脉瓣置换系统对高风险的主动脉瓣狭窄患者是安全有效的。

JACC:CT定义降低假体-患者不匹配发生频率和严重程度,并与TAVR术后不良结局无关

EOAi CT降低TAVR后患者PPM的发生频率和严重程度,与TAVR后1年死亡率无关。

JACC:经导管主动脉瓣置换后的死亡和透析

在未调整和调整的分析中,术前GFR与死亡和新RRT结局相关。

JACC:围手术期心肌损伤取决于经导管心脏瓣膜类型,但不预测TAVR后死亡率

TF TAVR后的心肌损伤很常见。心脏生物标志物升高的程度取决于THV类型,但与顺利的TAVR后长短期不良结局无关。

JACC:慢性肾病与经导管主动脉瓣置换住院结局的关系

CKD或ESRD患者TAVR后的住院结局差。