TAVR术后主动脉瓣置换术：与非savr心脏手术的长期比较结果。

IF 2.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology Pub Date : 2025-09-24 DOI:10.1016/j.amjcard.2025.09.009

Osamah Badwan, Issam Motairek, Fawzi Zghyer, Rishi Puri, Grant Reed, Amar Krishnaswamy, James Yun, Samir Kapadia

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引用次数: 0

摘要

背景：随着TAVR使用的扩大，一些患者需要后期的心脏手术，包括在某些情况下的SAVR与TAVR瓣膜外植体。与其他心脏手术相比，TAVR术后SAVR的长期风险尚不清楚。方法：我们研究了TriNetX网络中在2010年至2023年间接受TAVR术后SAVR或非SAVR直视心脏手术（OHS）的成年人。对26个临床和人口学因素进行倾向评分匹配。我们比较了3年和5年的结果。结果：配对后，每组纳入132例患者。各组在基线时平衡良好。3年死亡率相似（18.9% SAVR vs 22.0% OHS; HR 0.83, 95% CI 0.46-1.51）。5年时，死亡率保持可比性（20.5% vs 24.2%; OR 0.80, 95% CI 0.45-1.44）。卒中、急性冠状动脉综合征、心力衰竭住院、大出血、新发心房颤动和肾衰竭的发生率也相似。结论：与OHS相比，TAVR术后SAVR的长期预后相似。这些发现表明，风险可能更多地与患者的复杂性有关，而不是与瓣膜移植本身有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Surgical Aortic Valve Replacement Following TAVR: Long-Term Comparative Outcomes Versus Non-SAVR Cardiac Surgery.

Background: As TAVR use expands, some patients require later cardiac surgery, including SAVR with TAVR valve explant in certain scenarios. The long-term risks of SAVR after TAVR compared with other cardiac surgeries remain unclear.

Methods: We studied adults in the TriNetX network who underwent TAVR followed by either SAVR or non-SAVR open-heart surgery (OHS) between 2010 and 2023. Propensity-score matching was done on 26 clinical and demographic factors. We compared outcomes at 3 and 5 years.

Results: After matching, 132 patients were included in each group. The groups were well balanced at baseline. At 3 years, mortality was similar (18.9% SAVR vs 22.0% OHS; HR 0.83, 95% CI 0.46-1.51). At 5 years, mortality remained comparable (20.5% vs 24.2%; OR 0.80, 95% CI 0.45-1.44). Rates of stroke, acute coronary syndrome, heart failure hospitalization, major bleeding, new atrial fibrillation, and renal failure were also similar.

Conclusions: SAVR after TAVR was associated with similar long-term outcomes compared with OHS. These findings suggest that risks may be more related to patient complexity than to the valve explant itself.

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来源期刊

American Journal of Cardiology 医学-心血管系统

CiteScore

4.00

自引率

3.60%

发文量

698

审稿时长

33 days

期刊介绍： Published 24 times a year, The American Journal of Cardiology® is an independent journal designed for cardiovascular disease specialists and internists with a subspecialty in cardiology throughout the world. AJC is an independent, scientific, peer-reviewed journal of original articles that focus on the practical, clinical approach to the diagnosis and treatment of cardiovascular disease. AJC has one of the fastest acceptance to publication times in Cardiology. Features report on systemic hypertension, methodology, drugs, pacing, arrhythmia, preventive cardiology, congestive heart failure, valvular heart disease, congenital heart disease, and cardiomyopathy. Also included are editorials, readers'' comments, and symposia.