JACC:经导管肺动脉瓣置换术后的中期和长期预后

2022-01-07 xiaozeng MedSci原创

在广泛的年龄范围内,经导管肺动脉瓣置换术后患者的预后与外科导管/瓣膜置换术的相当

自20年前首次实施经导管肺动脉瓣 (TPV) 置换术(TPVR)以来,经导管肺动脉瓣置换术现已成为修复导管/瓣膜患者术后肺流出道功能障碍的标准治疗方法。但是,迄今为止,关于手术后死亡或再干预的危险因素的信息有限。

本研究目的是在一项大型的多中心队列中评估 TPVR 后的中期和长期预后。

共纳入了 2476 位接受 TPVR 的患者的数据,共随访了 8475 人·年。有 95 位患者在 TPVR 后死亡,大部分是死于心脏衰竭(n=24)。TPVR 后 8 年的累积死亡率是 8.9%(95% CI 6.9%-11.5%)。

受试患者的死亡原因

在多变量分析中,TPVR 时的年龄(HR 1.04/岁,95% CI 1.03-1.06/岁,p<0.001)、在其他位置的假体瓣膜 (HR 2.1; 95% CI 1.2-3.7,p=0.014) 和存在经静脉起搏器/植入式心律转复除颤器 (HR 2.1,95% CI 1.3-3.4,p=0.004) 都与死亡风险相关。

TPVR 后患者的各种预后情况

共有 258 位患者经历了 TPV 再干预。第 8 年时,任何 TPV 再干预的累积发生率为 25.1% (95% CI 21.8%-28.5%),手术 TPV 再干预的累积发生率为 14.4% (95% CI 11.9%-17.2%)。

不同年龄段的患者TPVR后的生存率

手术再干预的风险因素有年龄(0.95/岁,95% CI 0.93-0.97/岁,p<0.001)、既往心内膜炎 (2.5,95% CI 1.4-4.3,p<0.001)、植入支架生物瓣膜 (1.7,95% CI 1.2-2.5,p=0.007) 和植入后的梯度(1.4/10 mmHg,95% CI 1.2-1.7/10 mmHg, p<0.001)。

综上,该研究结果表明,在广泛的年龄范围内,TPVR 后的生存率和无再干预/手术情况与外科导管/瓣膜置换术的预后相当

原始出处:

Doff B. McElhinney, et al. Reintervention and Survival After Transcatheter Pulmonary Valve Replacement. J Am Coll Cardiol. 2022 Jan, 79 (1) 18–32

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  6. 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    2022-01-09 屋顶瞄爱赏月

    学习了

    0

  7. 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encodeId=0d1015e682724, content=<a href='/topic/show?id=48fee966468' target=_blank style='color:#2F92EE;'>#置换术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79664, encryptionId=48fee966468, topicName=置换术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=054816326830, createdName=ms117281293605716, createdTime=Sun Jan 09 07:40:16 CST 2022, time=2022-01-09, status=1, ipAttribution=)]
    2022-01-09 齐广西

    学习了

    0

  8. 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  9. 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    2022-01-09 lsj631
  10. 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