JACC:预扩张vs无预扩张植入自扩张瓣膜的TAVR

2019-03-31 xiangting MedSci原创

无球囊预扩张、使用自扩张瓣膜系统的直接经导管主动脉瓣置换术不劣于预扩张手术。

这项研究目的是在一项开放标签、非劣效性、随机试验中比较使用或不使用球囊主动脉瓣成形术(BAV)的自扩张瓣膜植入。

目前没有比较使用(pre-BAV)或不使用BAV自扩张瓣膜植入的随机研究。

将严重主动脉瓣狭窄的连续性患者随机分配接受使用预扩张(pre-BAV)自扩张瓣膜的经导管主动脉瓣置换术,或不使用预扩张(no-BAV)的TAVR。主要终点是根据瓣膜学术研究联盟2标准的装置成功率。次要终点包括围手术期死亡率和卒中、新的永久起搏器植入、血管并发症和1年死亡率。该试验还显示直接TAVR与pre-BAV方法比较的非劣效性(Δ=15%)。

共有171例患者在4个中心被随机分组。其中,86例接受预扩张的经导管主动脉瓣置换术, 85例无预扩张。no-BAV组的装置成功率不差于pre-BAV组(no-BAV组为65/85例[76.5%],pre-BAV组为64/86例[74.4%];平均差异2.1%;90%置信区间:-8.9%至13%)。在non-BAV组中,25例患者(29.4%)接受球囊后扩张,而在pre-BAV组中,13例患者(15.1%)接受球囊后扩张(p=0.03)。两组间的主要血管并发症和永久起搏器植入没有差异(log-rank p=0.49,log-rank p=0.54)。在所有患者完成的1个月随访中,有1例围手术期卒中(0.5%),无死亡。

无球囊预扩张、使用自扩张瓣膜系统的直接经导管主动脉瓣置换术不劣于预扩张手术。预扩张组的球囊后扩张率较低。(经导管主动脉瓣植入的预扩张试验[DIRECT];NCT02448927)

原始出处:

Konstantinos Toutouzas. Pre-Dilatation Versus No Pre-Dilatation for Implantation of a Self-Expanding Valve in All Comers Undergoing TAVR The DIRECT Trial. JACC:Cardiovascular Interventions. March 2019.

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    2019-11-26 hbwxf
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    2019-08-06 weiz
  5. [GetPortalCommentsPageByObjectIdResponse(id=1684781, encodeId=c8001684e8154, content=<a href='/topic/show?id=794754e74f4' target=_blank style='color:#2F92EE;'>#扩张#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54774, encryptionId=794754e74f4, topicName=扩张)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8e886, createdName=仁者大医, createdTime=Thu Jul 11 21:39:00 CST 2019, time=2019-07-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1854347, encodeId=9111185434e1b, content=<a href='/topic/show?id=48351020537' target=_blank style='color:#2F92EE;'>#JACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10205, encryptionId=48351020537, topicName=JACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Tue Nov 26 12:39:00 CST 2019, time=2019-11-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2086360, encodeId=ca9120863609b, content=<a href='/topic/show?id=134b304456' target=_blank style='color:#2F92EE;'>#AVR#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3044, encryptionId=134b304456, topicName=AVR)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7d74253, createdName=wangtianj2007@, createdTime=Fri Aug 23 11:39:00 CST 2019, time=2019-08-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2076176, encodeId=113c20e617623, content=<a href='/topic/show?id=d89d100214b6' target=_blank style='color:#2F92EE;'>#预扩张#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100214, encryptionId=d89d100214b6, topicName=预扩张)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1c77441, createdName=weiz, createdTime=Tue Aug 06 13:39:00 CST 2019, time=2019-08-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1326167, encodeId=0f3f132616e21, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Tue Apr 02 01:39:00 CST 2019, time=2019-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1520569, encodeId=168715205693a, content=<a href='/topic/show?id=7a736264553' target=_blank style='color:#2F92EE;'>#植入#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62645, encryptionId=7a736264553, topicName=植入)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=832411313664, createdName=jiyangfei, createdTime=Tue Apr 02 01:39:00 CST 2019, time=2019-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1583613, encodeId=da3a1583613cb, content=<a href='/topic/show?id=508d68e698c' target=_blank style='color:#2F92EE;'>#瓣膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, 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=Tue Apr 02 01:39:00 CST 2019, time=2019-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1597111, encodeId=223e159e11101, content=<a href='/topic/show?id=ff5c8619e13' target=_blank style='color:#2F92EE;'>#自扩张瓣膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=86197, encryptionId=ff5c8619e13, topicName=自扩张瓣膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=26a518488431, createdName=zhangyxzsh, createdTime=Tue Apr 02 01:39:00 CST 2019, time=2019-04-02, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=1684781, encodeId=c8001684e8154, content=<a href='/topic/show?id=794754e74f4' target=_blank style='color:#2F92EE;'>#扩张#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54774, encryptionId=794754e74f4, topicName=扩张)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8e886, createdName=仁者大医, createdTime=Thu Jul 11 21:39:00 CST 2019, time=2019-07-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1854347, encodeId=9111185434e1b, content=<a href='/topic/show?id=48351020537' target=_blank style='color:#2F92EE;'>#JACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10205, encryptionId=48351020537, topicName=JACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Tue Nov 26 12:39:00 CST 2019, time=2019-11-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2086360, encodeId=ca9120863609b, content=<a href='/topic/show?id=134b304456' target=_blank style='color:#2F92EE;'>#AVR#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3044, encryptionId=134b304456, topicName=AVR)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7d74253, createdName=wangtianj2007@, createdTime=Fri Aug 23 11:39:00 CST 2019, time=2019-08-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2076176, encodeId=113c20e617623, content=<a href='/topic/show?id=d89d100214b6' target=_blank style='color:#2F92EE;'>#预扩张#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100214, encryptionId=d89d100214b6, topicName=预扩张)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1c77441, createdName=weiz, createdTime=Tue Aug 06 13:39:00 CST 2019, time=2019-08-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1326167, encodeId=0f3f132616e21, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Tue Apr 02 01:39:00 CST 2019, time=2019-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1520569, encodeId=168715205693a, content=<a href='/topic/show?id=7a736264553' target=_blank style='color:#2F92EE;'>#植入#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62645, encryptionId=7a736264553, topicName=植入)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=832411313664, createdName=jiyangfei, createdTime=Tue Apr 02 01:39:00 CST 2019, time=2019-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1583613, encodeId=da3a1583613cb, content=<a href='/topic/show?id=508d68e698c' target=_blank style='color:#2F92EE;'>#瓣膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, 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=Tue Apr 02 01:39:00 CST 2019, time=2019-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1597111, encodeId=223e159e11101, content=<a href='/topic/show?id=ff5c8619e13' target=_blank style='color:#2F92EE;'>#自扩张瓣膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=86197, encryptionId=ff5c8619e13, topicName=自扩张瓣膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=26a518488431, createdName=zhangyxzsh, createdTime=Tue Apr 02 01:39:00 CST 2019, time=2019-04-02, status=1, ipAttribution=)]
    2019-04-02 jiyangfei
  7. [GetPortalCommentsPageByObjectIdResponse(id=1684781, encodeId=c8001684e8154, content=<a href='/topic/show?id=794754e74f4' target=_blank style='color:#2F92EE;'>#扩张#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54774, encryptionId=794754e74f4, topicName=扩张)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8e886, createdName=仁者大医, createdTime=Thu Jul 11 21:39:00 CST 2019, time=2019-07-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1854347, encodeId=9111185434e1b, content=<a href='/topic/show?id=48351020537' target=_blank style='color:#2F92EE;'>#JACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10205, encryptionId=48351020537, topicName=JACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Tue Nov 26 12:39:00 CST 2019, time=2019-11-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2086360, encodeId=ca9120863609b, content=<a href='/topic/show?id=134b304456' target=_blank style='color:#2F92EE;'>#AVR#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3044, encryptionId=134b304456, topicName=AVR)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7d74253, createdName=wangtianj2007@, createdTime=Fri Aug 23 11:39:00 CST 2019, time=2019-08-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2076176, encodeId=113c20e617623, content=<a href='/topic/show?id=d89d100214b6' target=_blank style='color:#2F92EE;'>#预扩张#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100214, encryptionId=d89d100214b6, topicName=预扩张)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1c77441, createdName=weiz, createdTime=Tue Aug 06 13:39:00 CST 2019, time=2019-08-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1326167, encodeId=0f3f132616e21, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Tue Apr 02 01:39:00 CST 2019, time=2019-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1520569, encodeId=168715205693a, content=<a href='/topic/show?id=7a736264553' target=_blank style='color:#2F92EE;'>#植入#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62645, encryptionId=7a736264553, topicName=植入)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=832411313664, createdName=jiyangfei, createdTime=Tue Apr 02 01:39:00 CST 2019, time=2019-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1583613, encodeId=da3a1583613cb, content=<a href='/topic/show?id=508d68e698c' target=_blank style='color:#2F92EE;'>#瓣膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, 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=Tue Apr 02 01:39:00 CST 2019, time=2019-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1597111, encodeId=223e159e11101, content=<a href='/topic/show?id=ff5c8619e13' target=_blank style='color:#2F92EE;'>#自扩张瓣膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=86197, encryptionId=ff5c8619e13, topicName=自扩张瓣膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=26a518488431, createdName=zhangyxzsh, createdTime=Tue Apr 02 01:39:00 CST 2019, time=2019-04-02, status=1, ipAttribution=)]
  8. [GetPortalCommentsPageByObjectIdResponse(id=1684781, encodeId=c8001684e8154, content=<a href='/topic/show?id=794754e74f4' target=_blank style='color:#2F92EE;'>#扩张#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54774, encryptionId=794754e74f4, topicName=扩张)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8e886, createdName=仁者大医, createdTime=Thu Jul 11 21:39:00 CST 2019, time=2019-07-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1854347, encodeId=9111185434e1b, content=<a href='/topic/show?id=48351020537' target=_blank style='color:#2F92EE;'>#JACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10205, encryptionId=48351020537, topicName=JACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Tue Nov 26 12:39:00 CST 2019, time=2019-11-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2086360, encodeId=ca9120863609b, content=<a href='/topic/show?id=134b304456' target=_blank style='color:#2F92EE;'>#AVR#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3044, encryptionId=134b304456, topicName=AVR)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7d74253, createdName=wangtianj2007@, createdTime=Fri Aug 23 11:39:00 CST 2019, time=2019-08-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2076176, encodeId=113c20e617623, content=<a href='/topic/show?id=d89d100214b6' target=_blank style='color:#2F92EE;'>#预扩张#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100214, encryptionId=d89d100214b6, topicName=预扩张)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1c77441, createdName=weiz, createdTime=Tue Aug 06 13:39:00 CST 2019, time=2019-08-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1326167, encodeId=0f3f132616e21, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Tue Apr 02 01:39:00 CST 2019, time=2019-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1520569, encodeId=168715205693a, content=<a href='/topic/show?id=7a736264553' target=_blank style='color:#2F92EE;'>#植入#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62645, encryptionId=7a736264553, topicName=植入)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=832411313664, createdName=jiyangfei, createdTime=Tue Apr 02 01:39:00 CST 2019, time=2019-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1583613, encodeId=da3a1583613cb, content=<a href='/topic/show?id=508d68e698c' target=_blank style='color:#2F92EE;'>#瓣膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, 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=Tue Apr 02 01:39:00 CST 2019, time=2019-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1597111, encodeId=223e159e11101, content=<a href='/topic/show?id=ff5c8619e13' target=_blank style='color:#2F92EE;'>#自扩张瓣膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=86197, encryptionId=ff5c8619e13, topicName=自扩张瓣膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=26a518488431, createdName=zhangyxzsh, createdTime=Tue Apr 02 01:39:00 CST 2019, time=2019-04-02, status=1, ipAttribution=)]