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Circulation:手术中危的严重症状性主动脉瓣狭窄患者单独介入与外科主动脉瓣植入的比较

2018-10-07 xiangting MedSci原创

TAVR中危患者的年龄和基线特征与SAVR患者存在显著差异。

经导管主动脉瓣置换术(TAVR)越来越多地被用于治疗外科主动脉瓣置换(SAVR)中危的严重主动脉瓣狭窄患者。目前,比较手术中危患者进行单独TAVR与SAVR适应症和临床结局的真实数据很少。

这项研究比较了手术中危患者(胸外科医师协会[STS]评分4% - 8%)的临床特征和结局,这些患者在前瞻性、all comers德国主动脉瓣注册(GARY)中接受单独的TAVR或常规SAVR治疗。

2012年至2014年期间,共有7613名手术中危患者在德国92个地点接受了单独的TAVR(n=6469)或SAVR(n=1144)。TAVR治疗患者的年龄显著较大(82.5±5.0 vs 76.6±6.7岁,p<0.001),并且具有较高的风险评分(logistic EuroSCORE:21.2±12.3% vs 14.2±9.5,p<0.001; STS评分:5.6±1.1 vs 5.2±1.0,p<0.001)。多因素分析显示,高龄、冠脉疾病、纽约心脏病协会心功能分级III/IV级、肺动脉高压、既往心脏失代偿、选择性手术、动脉闭塞性疾病、无糖尿病和主动脉瓣面积较小与进行TAVR而不进行SAVR相关(p均<0.001)。TAVR和SAVR的未调整院内死亡率相当(3.6%vs 3.6%,p=0.976),而TAVR患者的未调整1年死亡率显著较高(17.5% vs 10.8%,p<0.001)。在倾向评分匹配后,TAVR和SAVR患者1年死亡率的差异不再有显著性(17.1% vs 15.7%,p=0.59)。

TAVR中危患者的年龄和基线特征与SAVR患者存在显著差异。单独的TAVR和SAVR与院内死亡率3.6%相关。在倾向评分分析中,TAVR和SAVR患者的1年死亡率没有显著差异。

原始出处:

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