TCT 2022:TAVR 和 SAVR 治疗趋势,近50%重度主动脉瓣狭窄患者进行TAVR治疗

2022-09-17 MedSci原创 MedSci原创

在美国,TAVR 治疗可能超过 SAVR治疗,疗效继续改善!

毫无疑问,经导管主动脉瓣置换术(TAVR)和外科主动脉瓣置换术(SAVR)的出现改变了主动脉瓣狭窄患者的临床管理。916日,世界介入心血管医学的重要会议——2022年美国经导管心血管治疗学术会议(TCT 2022)大会将在波士顿举行。在此次大会上,一项针对美国全国人口的研究显示,在65岁以下的重度主动脉瓣狭窄患者中,TAVR的比例几乎与SAVR的比例相当。

研究人员Toishi Sharma指出,“2020年美国心脏协会/美国心脏病学会(AHA/ACC)相关指南推荐,65岁以下的严重主动脉瓣狭窄患者采用SAVR,然而我们发现,截止到2021年,这些患者TAVRSAVR的使用率几乎一样,分别为48%52%

在这项研究中,研究人员分析了来自美国的Vizient临床数据库,该数据库包含了 250 多家进行 TAVR SAVR 的美国学术中心,收纳了2015101日至20211231日因主动脉瓣狭窄而接受TAVRSAVR治疗的142953名患者,并根据年龄进行分组,分成三组: < 65 岁、65-80 岁以及> 80 岁。从从 2015 年到 2021 年,三个年龄组的瓣膜置换率变化如下:

• < 65 岁:TAVR 17% 上升到 48%SAVR 83% 下降到 52%

• 65-80 岁:TAVR 46% 上升到 87%SAVR 54% 下降到 12%

• > 80 岁:TAVR 83% 上升到 99%SAVR 16% 下降到 1%

研究者表示,在所有年龄组中,TAVR 治疗包括在年轻患者在内的所有年龄组中都有显著增长。令人惊讶是,与指南相矛盾的是 TAVR 治疗在 65 岁以下年轻患者中继续增长。

大多数关于TAVR治疗的研究仅限于随机试验中的患者,他们主要是70多岁到80多岁的人群,其中一些患者在10年的随访前就已经去世。欧洲指南建议,70岁以下的患者进行手术,那么,目前TAVR是治疗否是现在的首选方法,这也是一件很有趣的事情。研究者指出。

当然,来自科罗拉多大学安舒茨医学校区Carroll教授表示,年龄只是考虑使用TAVRSAVR治疗的多种患者特征之一。SAVR经常与其他外科手术一起进行,这是SAVR仍然是瓣膜性心脏病的重要治疗方法。

Carroll教授强调,未来需要对TAVRSAVR耐用性的长期数据进行比较,到目前为止,没有显著差异,但充分了解TAVR使用的各种模型仍然是关键。用于成人的TAVRSAVR都是组织瓣膜如果患者活得够久,所有组织瓣膜最终都会失效。

患者管理策略需要考虑的是当第一个瓣膜失效时,还有哪些治疗选择。如果第一个瓣膜是SAVR,将TAVR瓣膜置于失败的SAVR瓣膜内,即所谓的瓣中瓣或TAVR-in-SAVR。这是大多数SAVR瓣膜失效患者的首选治疗方法。然而,我们对于TAVR-in-SAVR了解也并不是很多。

总之,这项研究的发现对接受 TAVR 65岁以下的患者终生管理具有重要意义,包括冠状动脉通路和瓣膜耐久性等。

参考资料

https://www.medscape.com/viewarticle/980936#vp_1

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    2022-09-19 Smile2684

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