经导管主动脉瓣置换术时代主动脉瓣手术尺寸和选择的变化

IF 1.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Zachary M Gertz, Raymond J. Strobel, Alex M. Wisniewski, Clifford E. Fonner, Alan Speir, N. Teman, Mohammed Quader
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引用次数: 0

摘要

目的。经导管主动脉瓣置换术(TAVR)的采用改变了转诊为手术主动脉瓣置换术(SAVR)患者的情况,并引起了对瓣膜尺寸和耐用性的更多关注。我们研究了 TAVR 对 SAVR 实践的影响。方法。我们使用全州数据库评估了所有孤立的 SAVR,并将其分为三个时代:TAVR 前(2008 年至 2011 年)、TAVR 早期(2012 年至 2015 年)和 TAVR 当前(2016 年至 2022 年)。主要研究结果是不同时期人工瓣膜尺寸和使用机械瓣膜比例的变化。研究结果共纳入6445名患者。在当前时代,SAVR 的数量有所下降。瓣膜的尺寸随着时间的推移而增大。在前TAVR时代,41%的患者接受了小于23毫米的瓣膜,这一比例在早期TAVR时代下降到33%,在当前时代又下降到22%(P < 0.001)。即使在控制了患者特征后,手术年份仍与选择更大的瓣膜密切相关。瓣环增大在当前的TAVR时代有所增加(P < 0.001)。机械瓣膜的使用在当前时代有所增加(与早期TAVR相比,p < 0.001)。回归分析表明,手术年份并不能预测机械瓣膜的使用情况,这表明实践的变化是由患者特征驱动的。结论。自采用TAVR以来,手术瓣膜的选择发生了变化,较小瓣膜的使用频率降低。机械瓣膜使用率的增加可能反映了患者群体的变化。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Changing Surgical Aortic Valve Size and Choices in the Transcatheter Aortic Valve Replacement Era
Objective. The adoption of transcatheter aortic valve replacement (TAVR) has changed the profile of patients referred for surgical aortic valve replacement (SAVR) and drawn more attention to valve sizing and durability. We examined the influence of TAVR on SAVR practice. Methods. Using a statewide database, we evaluated all isolated SAVRs, categorized into three eras: pre-TAVR (2008 to 2011), early TAVR (2012 to 2015), and current-TAVR (2016 to 2022). The primary outcomes of interest were changes in prosthetic valve size and the percentage of mechanical valves used between time periods. Results. There were 6,445 patients included. SAVR volume declined in the current era. Valve size increased over time. In the pre-TAVR era, 41% of patients received a valve smaller than 23 mm, which declined to 33% in the early TAVR era, then to 22% in the current era (p < 0.001 for all). The year of surgery was significantly associated with larger valve selection even after controlling for patient characteristics. Annular enlargement rose in the current-TAVR era (p < 0.001). The use of mechanical valves rose in the current era (p < 0.001 compared to early TAVR). Regression analysis showed that the year of surgery was not predictive of mechanical valve use, suggesting that changes in practice were driven by patient characteristics. Conclusion. Surgical valve choice since the adoption of TAVR has changed, with less frequent use of smaller valves. Increases in mechanical valve usage are likely a reflection of changing patient population.
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来源期刊
CiteScore
2.90
自引率
12.50%
发文量
976
审稿时长
3-8 weeks
期刊介绍: Journal of Cardiac Surgery (JCS) is a peer-reviewed journal devoted to contemporary surgical treatment of cardiac disease. Renown for its detailed "how to" methods, JCS''s well-illustrated, concise technical articles, critical reviews and commentaries are highly valued by dedicated readers worldwide. With Editor-in-Chief Harold Lazar, MD and an internationally prominent editorial board, JCS continues its 20-year history as an important professional resource. Editorial coverage includes biologic support, mechanical cardiac assist and/or replacement and surgical techniques, and features current material on topics such as OPCAB surgery, stented and stentless valves, endovascular stent placement, atrial fibrillation, transplantation, percutaneous valve repair/replacement, left ventricular restoration surgery, immunobiology, and bridges to transplant and recovery. In addition, special sections (Images in Cardiac Surgery, Cardiac Regeneration) and historical reviews stimulate reader interest. The journal also routinely publishes proceedings of important international symposia in a timely manner.
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