JAHA:经导管或外科主动脉瓣置换术后感染性心内膜炎的发生率和结局

2021-09-28 MedSci原创 MedSci原创

将TAVR与SAVR进行比较的前瞻性收集数据显示,无论治疗方式如何,IE的累积风险较低,尽管TAVR植入组的风险较低。一旦发生IE,死亡率就很高。

比较经导管(TAVR)与外科主动脉瓣置换术(SAVR)后感染性心内膜炎(IE)的发生频率和结局的数据很少。

近日,血管疾病领域权威杂志JAHA上发表了一篇研究文章,该研究的目的是比较SAVR和TAVR后IE的发生率和患者结局。

该研究汇总了3项比较TAVR与SAVR的随机临床试验和一项前瞻性持续TAVR访问研究的数据。IE是根据修改后的杜克标准定义的。IE的累积发生率是通过对特定原因风险进行建模来确定的。研究人员通过Kaplan-Meier方法计算了全因死亡率的估计值,并报告了瓣膜植入队列的结局。

在平均2.17±1.51年的随访期间,2249名接受TAVR的患者中有12名(0.5%)和1828名接受SAVR的患者中有21名(1.1%)患者发生了IE。IE患者比没有IE的患者更常患糖尿病(57.6% vs. 34.2%;P=0.005)。5年TAVR后IE的累积发生率为1.01%(95%CI为0.47%-1.96%),SAVR后为1.58%(95%CI为0.97%-2.46%)(P=0.047)。在IE患者中,TAVR组1年的全因死亡率为27.3%(95%CI为1.0%-53.6%),SAVR组为51.8%(95%CI为28.2%-75.3%)(对数秩P=0.15)。

由此可见,将TAVR与SAVR进行比较的前瞻性收集数据显示,无论治疗方式如何,IE的累积风险较低,尽管TAVR植入组的风险较低。一旦发生IE,死亡率就很高。

原始出处:

Jonas Lanz.et al.Incidence and Outcomes of Infective Endocarditis After Transcatheter or Surgical Aortic Valve Replacement.JAHA.2021.https://www.ahajournals.org/doi/full/10.1161/JAHA.120.020368

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status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1415778, encodeId=31841415e788b, content=<a href='/topic/show?id=04812314540' target=_blank style='color:#2F92EE;'>#主动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23145, encryptionId=04812314540, topicName=主动脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=77603112682, createdName=circumcision, createdTime=Thu Sep 30 10:46:01 CST 2021, time=2021-09-30, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1826732, encodeId=982c1826e3299, content=<a href='/topic/show?id=e5283e89970' target=_blank style='color:#2F92EE;'>#发生率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37899, encryptionId=e5283e89970, topicName=发生率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30bd35, createdName=一叶知秋, createdTime=Tue Nov 02 03:46:01 CST 2021, time=2021-11-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1708662, encodeId=39c31e086628f, content=<a href='/topic/show?id=4c2d3051535' target=_blank style='color:#2F92EE;'>#内膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30515, encryptionId=4c2d3051535, topicName=内膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=730431558473, 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channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2118, encryptionId=922f21183d, topicName=AHA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bf3d82, createdName=zhaohui6731, createdTime=Thu Sep 30 10:46:01 CST 2021, time=2021-09-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1332811, encodeId=3116133281146, content=<a href='/topic/show?id=1dd6231822d' target=_blank style='color:#2F92EE;'>#主动脉瓣#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23182, encryptionId=1dd6231822d, topicName=主动脉瓣)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dc4b2500077, createdName=hittouch, createdTime=Thu Sep 30 10:46:01 CST 2021, time=2021-09-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1350759, encodeId=98261350e597a, content=<a 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status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1415778, encodeId=31841415e788b, content=<a href='/topic/show?id=04812314540' target=_blank style='color:#2F92EE;'>#主动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23145, encryptionId=04812314540, topicName=主动脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=77603112682, createdName=circumcision, createdTime=Thu Sep 30 10:46:01 CST 2021, time=2021-09-30, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=1826732, encodeId=982c1826e3299, content=<a href='/topic/show?id=e5283e89970' target=_blank style='color:#2F92EE;'>#发生率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37899, encryptionId=e5283e89970, topicName=发生率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30bd35, createdName=一叶知秋, createdTime=Tue Nov 02 03:46:01 CST 2021, time=2021-11-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1708662, encodeId=39c31e086628f, content=<a href='/topic/show?id=4c2d3051535' target=_blank style='color:#2F92EE;'>#内膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30515, encryptionId=4c2d3051535, topicName=内膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=730431558473, 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href='/topic/show?id=a32d508e8c3' target=_blank style='color:#2F92EE;'>#心内膜炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50878, encryptionId=a32d508e8c3, topicName=心内膜炎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Thu Sep 30 10:46:01 CST 2021, time=2021-09-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1367237, encodeId=2970136e237f8, content=<a href='/topic/show?id=b6222320322' target=_blank style='color:#2F92EE;'>#主动脉瓣置换术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23203, encryptionId=b6222320322, topicName=主动脉瓣置换术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0b24249, createdName=medsci246, createdTime=Thu Sep 30 10:46:01 CST 2021, time=2021-09-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1415778, encodeId=31841415e788b, content=<a href='/topic/show?id=04812314540' target=_blank style='color:#2F92EE;'>#主动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23145, encryptionId=04812314540, topicName=主动脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=77603112682, createdName=circumcision, createdTime=Thu Sep 30 10:46:01 CST 2021, time=2021-09-30, status=1, ipAttribution=)]
    2021-09-30 zhaohui6731
  7. 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葛均波院士团队完成国内首例一站式TAVR+PTSMA术

4月18日,复旦大学附属中山医院葛均波院士团队完成一例“一站式” 经导管主动脉瓣置换+经皮腔内室间隔心肌消融术(TAVR+PTSMA)。通过文献检索证实,国内尚未有同类手术报道

JACC:常规超声或X线的使用以及经股动脉TAVR后出血的风险

FCA或2D-US引导股动脉穿刺可能出现血管和出血并发症。

JAHA:经导管主动脉瓣置换后合并症的负担和不良结局

TAVR治疗的高危患者临床结局较差。标准风险评估未能充分反映与合并症负担相关的风险,对合并症进行系统的评估可能会改善TAVR患者的风险分层。