NEJM:经导管或手术主动脉瓣置换的五年结局比较

2020-02-27 xing.T MedSci原创

由此可见,具有中等手术风险的主动脉瓣狭窄患者TAVR后5年死亡或致残性卒中的发生率与手术主动脉瓣置换相比无显著差异。

与经手术主动脉瓣置换术相比,严重的主动脉瓣狭窄且手术风险中等的患者经导管主动脉瓣置换术(TAVR)后的长期临床结局和生物修复瓣膜功能的数据很少。

近日,顶级医学期刊NEJM上发表了一篇研究文章,研究人员在57个中心招募了2032例具有严重症状性主动脉瓣狭窄的中危患者。根据预期的经股动脉或经胸入路将患者分层(分别为76.3%和23.7%),并随机分配接受TAVR或手术置换术。随访了5年的临床、超声心动图和健康状况结局。主要终点是因任何原因或卒中致死。

在5年时,TAVR组和手术组之间任何原因或致残性卒中的死亡发生率均无显著差异(分别为47.9%和43.4%;风险比为1.09;95%置信区间[CI]为0.95至1.25;P=0.21)。经股动脉置换术组的结果相似(分别为44.5%和42.0%;风险比为1.02;95%CI为0.87至1.20),但经胸腔镜手术后死亡或致残性卒中的发生率高于经胸手术患者(59.3%和48.3%;风险比为1.32;95%CI为1.02至1.71)。在5年时,TAVR组的患者至少有轻度的瓣周主动脉瓣关闭不全(33.3%和6.3%)。TAVR后的再次住院比手术置换术后更频繁(33.3%和25.2%),主动脉瓣再介入也较手术置换术后更为频繁(3.2%和0.8%)。TAVR和手术置换术患者在5年时的健康状况改善程度相似。

由此可见,具有中等手术风险的主动脉瓣狭窄患者TAVR后5年死亡或致残性卒中的发生率与手术主动脉瓣置换相比无显著差异。

原始出处:

Raj R. Makkar,et al.Five-Year Outcomes of Transcatheter or Surgical Aortic-Valve Replacement.NEJM.2020.https://www.nejm.org/doi/full/10.1056/NEJMoa1910555?query=featured_home

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    2021-01-22 yxch48
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    2020-02-29 lsj631
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    2020-02-27 旺医

    顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息

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