经导管主动脉瓣置换术后的神经并发症:综述。

IF 4.6 2区 医学 Q1 ANESTHESIOLOGY
Anesthesia and analgesia Pub Date : 2024-11-01 Epub Date: 2024-08-12 DOI:10.1213/ANE.0000000000007087
Adam S Mangold, Stefano Benincasa, Benjamin M Sanders, Kinjal Patel, Ludmil Mitrev
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引用次数: 0

摘要

经导管主动脉瓣置换术(TAVR)已成为美国主动脉瓣置换术的主要手术方式。据报道,TAVR 患者的神经系统并发症发生率随着时间的推移而变化,并取决于诊断定义和方式。大多数 TAVR 术后中风可能源于栓塞,随着时间的推移,中风的发生率有所下降。在比较 TAVR 和外科主动脉瓣置换术(SAVR)的卒中发生率时,研究结果相互矛盾,特别是由于诊断标准和神经认知测试的不同。在这篇叙述性综述中,我们总结了有关 TAVR 术后中风、谵妄和认知功能下降发生率的现有数据,并强调了未来需要研究的潜在领域。我们还讨论了无声脑缺血病变(SCIL)及其与 TAVR 术后神经认知能力下降的关系。最后,我们描述了当使用非股动脉通路时,谵妄和术后衰退的风险会增加,并强调需要标准化的成像和有效、可重复的方法来评估 TAVR 术后的认知变化。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Neurological Complications After Transcatheter Aortic Valve Replacement: A Review.

Transcatheter aortic valve replacement (TAVR) has become the dominant procedural modality for aortic valve replacement in the United States. The reported rates of neurological complications in patients undergoing TAVR have changed over time and are dependent on diagnostic definitions and modalities. Most strokes after TAVR are likely embolic in origin, and the incidence of stroke has decreased over time. Studies have yielded conflicting results when comparing stroke rates between TAVR and surgical aortic valve replacement (SAVR), especially due to differences in diagnostic criteria and neurocognitive testing. In this narrative review, we summarize the available data on the incidence of stroke, delirium, and cognitive decline after TAVR and highlight potential areas in need of future research. We also discuss silent cerebral ischemic lesions (SCILs) and their association with a decline in postoperative neurocognitive status after TAVR. Finally, we describe that the risk of delirium and postoperative decline is increased when nonfemoral access routes are used, and we highlight the need for standardized imaging and valid, repeatable methodologies to assess cognitive changes after TAVR.

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来源期刊
Anesthesia and analgesia
Anesthesia and analgesia 医学-麻醉学
CiteScore
9.90
自引率
7.00%
发文量
817
审稿时长
2 months
期刊介绍: Anesthesia & Analgesia exists for the benefit of patients under the care of health care professionals engaged in the disciplines broadly related to anesthesiology, perioperative medicine, critical care medicine, and pain medicine. The Journal furthers the care of these patients by reporting the fundamental advances in the science of these clinical disciplines and by documenting the clinical, laboratory, and administrative advances that guide therapy. Anesthesia & Analgesia seeks a balance between definitive clinical and management investigations and outstanding basic scientific reports. The Journal welcomes original manuscripts containing rigorous design and analysis, even if unusual in their approach.
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