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JAMA Cardiol:机械性瓣膜vs自扩张瓣膜经导管主动脉瓣置换术后的2年结局

2019-03-07 xiangting MedSci原创

Lotus组的致残性卒中、功能分级、瓣膜移位和PVL结果较好,而CoreValve组的瓣膜血流动力学、血栓形成和新起搏器植入结果较好。

据我们所知,REPRISE III是首个针对2种不同经导管主动脉瓣膜置换平台的大型随机比较研究:机械性扩张Lotus瓣(Boston科技)和自扩张CoreValve(美敦力)。

这项研究旨在评估Lotus vs CoreValve 2年后的结局。

在北美、欧洲和澳大利亚的55个中心,2014年9月22日至2015年12月24日期间共有912名高危/极高危的重度症状性主动脉瓣狭窄患者按照2:1被随机分配接受Lotus瓣膜(607 [66.6%])或CoreValve(305 [33.4%])。在2016年10月17日进行第一次2年访问,最后一次访问在2018年4月12日。在2年内完成临床和超声心动图评估,每年进行继续至第5年。

主要结局是全因死亡率和2年的全因死亡率或致残性卒中。其他临床因素包括总卒中、致残性卒中、重复手术、再入院、瓣膜血栓形成和起搏器植入。超声心动图分析包括有效瓣口面积、平均梯度和瓣周渗漏(PVLs)。

在912名参与者中,平均(SD)年龄为82.8岁(7.3),465名患者(51%)为女性,胸外科医师协会预测死亡风险平均值(SD)为6.8%(4.0%)。2年时,Lotus瓣膜的全因死亡率为21.3%,CoreValve为22.5%(风险比[HR],0.94; 95%CI,0.69-1.26; P= .67),Lotus瓣膜的全因死亡率或致残性卒中率为22.8%,CoreValve为27.0%(HR,0.81; 95%CI,0.61-1.07; P= .14)。总卒中发生率为8.4%vs 11.4%(HR,0.75; 95%CI,0.48-1.17; P= .21);与Lotus相比,CoreValve的致残性卒中更常见(Lotus 4.7%vs CoreValve 8.6%; HR,0.53; 95%CI,0.31-0.93; P= .02)。与CoreValve比较,更多的Lotus瓣膜患者接受新的永久起搏器植入(41.7%vs 26.1%; HR,1.87; 95%CI,1.41-2.49; P<.01)或有瓣膜血栓形成(3.0%vs 0.0%; P<.01)。与Lotus 瓣膜比较,CoreValve患者的重复手术(Lotus 0.6%vs CoreValve 2.9%; HR,0.19; 95%CI,0.05-0.70; P<.01)、瓣膜移位(0.0%vs 0.7%; P= .05)、或栓塞(0.0%vs 2.0%; P<.01)更常见。与Lotus 瓣膜比较,CoreValve的瓣膜面积明显较大且平均梯度较低(瓣膜面积,平均[SD]:Lotus,1.53 [0.49]cm2 vs CoreValve,1.76 [0.51]cm2 ; P<.01;瓣膜梯度,平均值[SD]:Lotus,13.0 [6.7]mmHg vs 8.1 [3.7]mmHg; P<.01)。?2年时,使用CoreValve 的中重度PVL更常见(Lotus 0.3%vs CoreValve 3.8%;P<.01)。与CoreValve相比,使用Lotus瓣膜的纽约心脏病协会(NYHA)功能分级改善更大(改善≥1个NYHA分级:Lotus,338/402 [84.1%] vs CoreValve,143/189[75.7%]; P=.01;改善≥2个NYHA分级:122/402 [37.3%] vs 65/305[21.3%])。

2年后,Lotus和CoreValve瓣膜的全因死亡率、死亡率或致残性卒中率相似。Lotus组的致残性卒中、功能分级、瓣膜移位和PVL结果较好,而CoreValve组的瓣膜血流动力学、血栓形成和新起搏器植入结果较好。

原始出处:

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    2019-11-21 lsj637
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    2019-04-27 yxch48
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  7. 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topicList=[TopicDto(id=23182, encryptionId=1dd6231822d, topicName=主动脉瓣)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dc4b2500077, createdName=hittouch, createdTime=Sat Mar 09 02:15:00 CST 2019, time=2019-03-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1367163, encodeId=7c6d136e1637d, content=<a href='/topic/show?id=b6222320322' target=_blank style='color:#2F92EE;'>#主动脉瓣置换术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23203, encryptionId=b6222320322, topicName=主动脉瓣置换术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0b24249, createdName=medsci246, createdTime=Sat Mar 09 02:15:00 CST 2019, time=2019-03-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1415476, encodeId=6a8e14154e624, content=<a href='/topic/show?id=04812314540' target=_blank style='color:#2F92EE;'>#主动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23145, encryptionId=04812314540, topicName=主动脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=77603112682, createdName=circumcision, createdTime=Sat Mar 09 02:15:00 CST 2019, time=2019-03-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1510204, encodeId=65b2151020403, content=<a href='/topic/show?id=e9bce8254ef' target=_blank style='color:#2F92EE;'>#经导管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78254, encryptionId=e9bce8254ef, topicName=经导管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=93e010191378, createdName=lsj631, createdTime=Sat Mar 09 02:15:00 CST 2019, time=2019-03-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1536564, encodeId=0aaa153656456, content=<a href='/topic/show?id=a894e826546' target=_blank style='color:#2F92EE;'>#经导管主动脉瓣置换#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78265, encryptionId=a894e826546, topicName=经导管主动脉瓣置换)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b38112697961, createdName=yytms, createdTime=Sat Mar 09 02:15:00 CST 2019, time=2019-03-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1576692, encodeId=39eb15e669266, 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=65, 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=Sat Mar 09 02:15:00 CST 2019, time=2019-03-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1583611, encodeId=f2a1158361160, content=<a href='/topic/show?id=508d68e698c' target=_blank style='color:#2F92EE;'>#瓣膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, 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=Sat Mar 09 02:15:00 CST 2019, time=2019-03-09, status=1, ipAttribution=)]
    2019-03-09 lsj631
  8. 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createdTime=Sat Mar 09 02:15:00 CST 2019, time=2019-03-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1583611, encodeId=f2a1158361160, content=<a href='/topic/show?id=508d68e698c' target=_blank style='color:#2F92EE;'>#瓣膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, 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=Sat Mar 09 02:15:00 CST 2019, time=2019-03-09, status=1, ipAttribution=)]
  9. 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  10. 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