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Trends nyob rau hauv Readmission Thiab Nqi Tom Qab Transcatheter Implantation Versus Surgical Aortic Valve Hloov cov neeg mob nrog raum tsis ua haujlwm

Mar 14, 2022

Hu rau:joanna.jia@wecistanche.com/ WhatsApp: 008618081934791

Yas Sanaiha, MD ua al


Cov neeg mob nroglub raumkev ua haujlwm tsis zoomuaj kev pheej hmoo ntxiv rau kev txhim kho aortic valve pathology. Nyob rau lub sijhawm tam sim no ntawm tus nqi raws li kev noj qab haus huv, kev sib piv ntawm transcatheter thiab phais aortic valve hloov (SAVR) kev nyeem ntawv kev ua tau zoo hauv cov pej xeem no tau lees paub. Txhua tus neeg laus cov neeg mob uas tau txais transcatheter lossis SAVR los ntawm 2011 txog 2014 tau txheeb xyuas siv Nationwide Readmissions Database, muaj cov ntaub ntawv rau ze li 50 feem pua ​​​​ntawm US tsev kho mob. Cov neeg mob tau ntxiv stratified limob ntevraumkab mobtheem 1 txog 5 nrog rau theem kawglub raumkab mobyuav tsum tau dialysis. Kaplan-Meier, Cox Hazard, thiab cov qauv kev hloov pauv hloov pauv ntau yam tau tsim los txheeb xyuas cov kev kwv yees ntawm kev nyeem ntawv thiab cov nqi. Ntawm 350,609 cais aortic valve hloov, 4.7 feem pua ​​​​ntawm cov neeg mob raug mob ntev.raumkab mobtheem 1 txog 5 lossis theem kawglub raumkab mob. Transcatheter aortic valve cov neeg mob nrogmob ntevraumkab mobtheem 1 txog 5 / lossis theem kawglub raumkab mobcov laus (81.9 vs 72.9 xyoo, p<0.0001) with="" a="" higher="" prevalence="" of="" heart="" failure="" (15.2="" vs="" 4.3%,="" p="0.04)," and="" peripheral="" vascular="" disease="" (31.1="" vs="" 22.8%,="" p=""><0.0001) compared="" to="" their="" savr="" counterparts.="" transcatheter="" aortic="" valve="" replacement="" in="">mob ntevraumkab mobtheem 1 txog 3 cov neeg mob tau txais kev nkag siab ntau dua vim lub plawv tsis ua haujlwm thiab kev tso pacemaker ntau dua li SAVR. Transcatheter aortic valve hloov tau cuam tshuam nrog cov nqi nce ntxiv piv nrog SAVR rau txhua tusraum tsis ua haujlwmcov neeg mob. Nyob rau hauv xaus, nyob rau hauv lub teb chaws cohort ntawm ntev thiab kawg-theemlub raum kab mobCov neeg mob, transcatheter aortic valve implantation tau txuam nrog kev tuag ntau ntxiv, kev nyeem ntawv rau cov mob ntev.raumkab mobtheem 1 txog 3, thiab cov nqi kho mob hauv tsev kho mob.

© 2019 Elsevier Inc. All rights reserved. (Am J Cardiol 2019;00:1-8)

Cistanche for kidney disease

Cistanchetubulosativ thaivraumkab mob, nyem qhov no kom tau txais cov qauv


Cov neeg mob nrog creatinine tshem tawm<20cc in="" or="" hemodialysis="" dependence="" have="" been="" excluded="" from="" all="" early="" pivotal="" clinical="" trials="" comparing="" transcatheter="" aortic="" valve="" implantation="" (tavi),="" surgical="" aortic="" valve="" replacement="" (savr),="" and="" medical="" treatment.1-3="" those="" with="" end-stage="">lub raumkab mob(ESRD) yog qhov ua rau ntxov ntxov valvular calcification thiab tau pom tias muaj kev tuag ntau dua nrog kev tswj hwm ntawm aortic stenosis piv rau lawv cov tsis yog ESRD counterparts.4,5 Tsis tas li ntawd, muaj lwm yam loj comorbidities nyob rau hauv cov neeg mob siab.lub raumkab mobtheoretically ua rau TAVI ib qho kev xaiv zoo nkauj uas muab nws qhov kev tsis txaus ntseeg tsis tshua muaj kev cuam tshuam thiab obviation ntawm cardiopulmonary bypass.6 Cov neeg mob nroglub raumkab mob, tshwj xeeb tshaj yog, nthuav tawm cov pab pawg sib tw nrog ntau zaus tsis tau npaj rov mus pw kho mob thiab siv cov peev txheej ntxiv.7 Nrog rau kev nthuav dav ntawm TAVI thiab nce kev siv tus nqi xa rov qab los ua tus cim surrogate rau qhov zoo ntawm kev saib xyuas, tus yam ntxwv ntawm cov txiaj ntsig kev kho mob thiab kev nkag mus hauv tsev kho mob. nyob rau hauv cov neeg mob uas txawv degrees ntawmlub raumtsis txausNws yog ib qho tsim nyog los xyuas kom meej cov tswv yim tsim nyog rau kev kho mob ntawm tus kab mob valvular.8,9 Peb xav tias cov neeg mob uas tau txais TAVI yuav muaj ntau dua tag nrho, thaum ntxov, thiab nruab nrab kev nyeem ntawv rau txhua theem ntawmlub raumua tsis tiavpiv nrog SAVR. Peb tau siv Nationwide Readmissions Database (NRD), qhov loj tshaj plaws muaj nyob rau hauv lub tebchaws United States, los muab ib tug niaj hnub lub teb chaws toj roob hauv pes ntawm kev tuag thiab readmission tshwm sim rau kev phais hloov thiab TAVI nyob rau hauv cov neeg mob.mob ntevraum kab mobthiab ESRD.

Cov txheej txheem

Xyoo 2011 txog 2014 NRD, qhov loj tshaj plaws uas muaj nyob rau hauv cov neeg them nyiaj tso tawm database khaws cia los ntawm Lub Chaw Haujlwm Saib Xyuas Kev Noj Qab Haus Huv thiab Kev Noj Qab Haus Huv, tau siv los txheeb xyuas cov neeg mob sib tw.10 Cov kev kho mob hauv tsev kho mob hauv NRD tau txais los ntawm ib tus neeg hauv Xeev Cov Ntaub Ntawv Kho Mob uas muaj cov neeg mob tus cim tso cai rau txuas mus ntsib cov tsev kho mob hauv tsev kho mob, tsis suav nrog kev kho kom rov zoo thiab cov tsev kho mob ntev mus ntev.10 NRD suav txog li 57.8 feem pua ​​​​ntawm tag nrho US kev tso tawm. Cov kev kwv yees hauv tebchaws tau txais los ntawm kev siv cov khoom hnyav uas tau muab rau txhua lub koom haum ua qauv. Txoj kev tshawb no tau raug zam los ntawm kev tshuaj xyuas los ntawm Pawg Saib Xyuas Kev Tshawb Fawb ntawm University of California, Los Angeles.

Cov kev tshawb fawb pawg tau muab los ntawm kwv yees li 17 lab txhua xyoo kev tso tawm tsis hnyav hauv NRD siv International Classification of Disease (ICD9) kev tswj hwm coding. Txhua tus neeg mob laus (Ntau dua lossis sib npaug li 18 xyoo) uas tau txais TAVI (ICD 35.05 thiab 35.06) thiab SAVR (ICD9 35.21 thiab 35.22) nrog kev kuaj mob Aortic Stenosis (ICD9 39.50 , 39.52, 42.41, thiab 74.63) hauv NRD tau txheeb xyuas. ICD9 coding tau siv los tshem tawm cov neeg mob uas tau txais kev sib koom ua ke ntawm cov hlab ntsha ntawm lub plawv bypass grafting, kho lub valve / hloov, kev cuam tshuam ntawm aortic arch, sab laug atrial appendage ligation, thiab cov cuab yeej pab ventricular lossis hloov pauv thaum nyob hauv tib lub tsev kho mob. Qhov hnyav ntawmlub raumtsis txaustau txhais los ntawm National Kidney FoundationLub raumKab mobCov txiaj ntsig tau zoo.11 Cov neeg mob tau muab faib ua pawg raws li qhov mob ntevraumkab mobrau txhua qhov kev txheeb xyuas raws li hauv qab no: Tsis yog-CKD, Theem 1-3 (CKD1-3), Theem 4-5 (CKD4-5), thiab ESRD, sawv cevlub raumkev ua haujlwm tsis zooyuav tsum tau lim ntshav (Daim duab 1). NRD cov ntsiab lus tau siv rau cov neeg mob thiab tsev kho mob qib hloov pauv xws li hnub nyoog, poj niam txiv neej, kev sib koom ua ke ntawm kev nkag mus, thiab lub txaj pw hauv tsev kho mob.10,12 Cov ntaub ntawv pov thawj yav dhau los ntawm Elixhauser comorbidity index tau suav los kwv yees qhov ntev ntawm cov kab mob ntev hauv cov ntaub ntawv tswj hwm no. .13 Cov tsev kawm ntawv qib siab TAVI tau raug txhais tias yog cov ua haujlwm tsawg kawg yog 50 TAVI ib xyoo NRD. DiagnosisRelated Groups (DRGs) tau siv los txheeb xyuas cov ntsiab lus tseem ceeb rau kev nyeem ntawv.

figure1

Cov txiaj ntsig tseem ceeb ntawm txoj kev tshawb no yog tus nqi ntawm txhua qhov ua rau 30- thiab 31-90 hnub nyeem ntawv tom qab tso tawm. Cov txiaj ntsig ntxiv tau suav nrog qhov ntsuas kev tuag hauv tsev kho mob, qhov ntev ntawm kev nyob (LOS), thiab cov nqi. Cov nqi raug suav los ntawm cov nqi tsev kho mob uas siv NRD Tus Nqi-rau-tus nqi sib piv thiab kev hloov kho tag nrho-hauv tsev-cov khoom lag luam luam tawm los ntawm US Bureau of Labor Statistics Consumer Price Index.
Txhua qhov kev txheeb xyuas kev txheeb xyuas tau ua tiav siv Stata 15 (StataCorp, College Station, Tx). Kev soj ntsuam-hnyav chi-squared tsom xam ntawm categorical variables thiab Kho Wald Test rau kev ntsuas tas mus li tau ua. Kruskal-Wallis xeem tau siv rau qhov sib txawv nrog rau sab laug-skewed faib. Cox proportional hazard thiab Kaplan-Meier tsom xam tau siv los txheeb xyuas tus neeg mob thiab tsev kho mobyam ntxwv cuam tshuam nrog kev nyeem ntawv. Cov qauv kab rov tav suav nrog cov neeg mob sib koom ua ke, hnub nyoog, poj niam txiv neej, cov teeb meem perioperative, tsev kho mob stratification raws li TAVI ntim siab, thiab kev tswj hwm hauv tsev kho mob, raws li muab los ntawm NRD, tau tsim los ntsuas qhov tshwm sim thawj zaug thiab theem nrab. Cov txiaj ntsig tau tshwm sim tau txiav txim siab siv TREND tsom xam.14

cistanche for renal disease

Cov txiaj ntsig

Ntawm 350,609 tus neeg mob uas tau hloov lub aortic valve, 155,579 tus neeg mob tau ntsib cov txheej txheem suav nrog (TAVI=36,070 thiab SAVR=119,509). Qhov twg ntawmlub raumtsis txausntawm cov pawg neeg tau pom nyob rau hauv daim duab 1. Piv nrog rau SAVR, TAVI cov neeg mob muaj feem ntau ntawm CKD1-3 (12.1 vs 5.8 feem pua, p<0.0001), ckd4-5="" (3.5="" vs="" 1.0%,="" p=""><0.0001), and="" esrd="" (2.9="" vs="" 1.5%,="" p=""><0.0001). on="" average,="" tavi="" patients="" with="" esrd="" were="" older="" and="" had="" higher="" rates="" of="" heart="" failure,="" chronic="" obstructive="" pulmonary="" disease,="" and="" peripheral="" vascular="" disease="" than="" their="" savr="" counterparts.="" esrd="" tavi="" patients="" had="" lower="" rates="" of="" baseline="" neurologic="" dysfunction="" and="" chronic="" blood="" loss="" anemia="" without="" any="" significant="" difference="" in="" obesity="" and="" hematologic="" malignancies.="" differences="" between="" tavi="" and="" savr="" patients="" grouped="" by="" the="" extent="" of="">raumkab mob, suav nrog cov nqi ntawm lub plawv tsis ua hauj lwm, keeb kwm ntawm myocardial infarction, kab mob peripheral vascular, thiab qhov ntsuas qhov tsis sib xws thiab cov txiaj ntsig tau txais txiaj ntsig tau qhia hauv Table 1.

table 1

Of the 2,189 hospitals included in the study, 721 performed both SAVR and TAVI. Among all CKD1-5 and ESRD patients, 73% underwent TAVI at hospitals within major metropolitan (>1 lab tus neeg nyob) thaj chaw. Tag nrho tus nqi ntawm TAVI siv (PTREND < 0.0001)="">

nrog kev loj hlob sai dua hauv cov neeg mob CKD1-5 thiab ESRD (Daim duab 2). Txhua degree ntawmlub raumkev ua haujlwm tsis zootau cuam tshuam nrog kev nce ntxiv ntawm kev tuag hauv tsev kho mob rau TAVI thiab SAVR (Daim duab 3). TAVI tau cuam tshuam nrog qhov sib txawv ntau dua ntawm kev pheej hmoo hauv tsev kho mob-hloov kev tuag piv nrog SAVR ntawm txhua theem ntawmlub raumtsis txaus. CKD1-3 muaj qhov sib txawv ntawm cov neeg tuag tsawg dua piv nrog CKD4-5 thiab ESRD rau TAVI thiab SAVR. Txawm li cas los xij, qhov sib txawv ntawm kev tuag hauv tsev kho mob rau txhua txoj kev phais tsis muaj qhov sib txawv ntawm CKD4-5 thiab ESRD. Hnub nyoog ntau dua 85 (qhov txawv piv txwv [OR] 2.8, 95 feem pua ​​​​CI 2.2 rau 39), poj niam txiv neej (los yog 1.9, 95 feem pua ​​​​CI 1.6 rau 2.2), thiab lub plawv tsis ua hauj lwm (los yog 1.7, 95 feem pua ​​CI 1.3 rau 2.2) yog tag nrho. qhov tseem ceeb kwv yees ntawm index tsev kho mob tuag. Mortality regression tsis suav nrog cov kev kwv yees no tau pom muaj kev sib raug zoo ntawm TAVI thiab kev tuag (Ntxiv A). Cov teeb meem ntawm kev phais tau nce qhov ua tau ntawm kev tuag los ntawm 13-fold (LOSSIS 12.9, 95 feem pua ​​​​CI 11.1 txog 15.1) thaum kis kab mob cuam tshuam nrog 10-fold nce hauv kev tuag (los yog 10.2, 95 feem pua ​​​​CI 7.8 rau 13.4).

figure 2

figure 3

Ua raws li TAVI thiab SAVR, tag nrho cov kab mob stroke rau tag nrho cov pej xeem suav nrog, cov neeg mob uas tsis yog ESRD, yog 3.0 feem pua ​​​​thiab 1.8 feem pua, raws li (p < 0.0001).="" cov="" neeg="" uas="" muaj="" ckd="" theem="" 4-5="" muaj="" kev="" pheej="" hmoo="" siab="" tshaj="" plaws="" hauv="" tsev="" kho="" mob="" stroke="" (2.9="" vs="" 3.8="" feem="" pua,="" p="0.36)" nrog="" cov="" nqi="" zoo="" sib="" xws="" rau="">
(2.3 vs 2.0 feem pua ​​, p=0.73) thiab ESRD (1.8 vs 1.9 feem pua ​​, p=0.91) tom qab TAVI thiab SAVR, feem. Txawm li cas los xij, tom qab kev pheej hmoo hloov pauv qhov txawv ntawm kev mob stroke tsis sib txawv hauv qhovlub raumua tsis tiavtsis yog aortic valve intervention pawg. Txawm li cas los xij, qhov tshwm sim ntawm cov teeb meem neurologic ua rau muaj qhov sib txawv ntawm qhov kev tuag ntawm kev tuag (los yog 3.7, 95 feem pua ​​​​CI 2.7 txog 5.1).

Tus nqi ntawm tus neeg mob pacemaker implantation tau siab dua rau cov neeg mob uas tau txais TAVI piv nrog SAVR (CKD{0}}, 10.7 vs 5.0 feem pua, p<0.0001; ckd4-5="" 12.6="" vs="" 5.1%,="" p=""><0.0001; esrd="" 10.6="" vs="" 5.7%,="" p="0.002)." risk-adjusted="" analysis="" of="" pacemaker="" implantation="" at="" the="" index="" hospitalization="" further="" demonstrated="" increased="" odds="" of="" this="" event="" with="" tavi="" for="" patients="" with="" ckd1-3="" (or="" 2.1="" 95%="" ci="" 1.5="" to="" 3.1),="" ckd4-5="" (or="" 2.7,="" 95%="" ci="" 1.4="" to="" 5.5),="" esrd="" (or="" 2.2,="" 95%="" ci="" 1.3-3.8)="" and="" those="" without="">lub raumb(OR 1.8, 95 feem pua ​​CI 1.5 txog 2.1).

Qhov ntsuas qhov ntsuas LOS tau ntev dua rau SAVR thoob plaws txhua qhovrenalua tsis tiavcov pab pawg tshwj tsis yog rau CKD1-3 thaum cov nqi ntsuas tsis tau hloov kho tau qis dua rau SAVR CKD1-3 tab sis zoo sib xws rau CKD4-5 thiab ESRD (Table 1). Qhov kev pheej hmoo-hloov kev tsom xam pom tau tias muaj kev nce nqi ntxiv nrog TAVI thev naus laus zis thiab nce qhov hnyav ntawmlub raumua tsis tiav(Daim duab 4).

figure 4

Kaplan-Meier nkhaus rau kev ywj pheej los ntawm kev nyeem ntawv yog qhia hauv daim duab 5 nrog TAVI ua haujlwm tsis zoo rau cov neeg mob CKD1-3 piv nrog SAVR tab sis zoo ib yam rau txhua pawg. Thaum 1 xyoos tom qab tso tawm, 34.6 feem pua ​​​​ntawm TAVI thiab 32.7 feem pua ​​​​ntawm cov neeg mob SAVR nroglub raumtau nyeem tsawg kawg ib zaug (p=0.51). Cov neeg mob ESRD muaj qhov zoo tshaj plaws tag nrho kev nyeem ntawv tus nqi thaum piv nrog CKD1-3 (46.7 vs 29.6 feem pua, p<0.0001) and="" ckd4-5="" (46.7="" vs="" 32.7%,="" p="0.002)." the="" median="" days="" to="" the="" first="" readmission="" did="" not="" differ="" significantly="" (all="" p="">0.5) nruab nrab ntawm TAVI thiab SAVR cov neeg mob thoob plaws txhua theem ntawmlub raum ua tsis tiav(CKD1-3: 21 vs 26 hnub; CKD45: 26 vs 25 hnub; ESRD 26 vs 22 hnub). Thaum 1 xyoos, SAVR cov neeg mob tau txais tsawg dua cov sijhawm nyeem ntawv piv nrog TAVI tsuas yog rau pawg CKD4-5 (1.4 vs 1.8 mus ntsib, p=0.008). Kaplan-Meier tsom xam los ntawm qhov hnyav ntawmlub raumkab mobyielded ib tug zoo sib xws rau CKD1-3 (log-rank p<0.0001) but="" not="" for="" ckd4-5="" or="" esrd="" patients="" (figure="" 5).="" after="" adjusting="" for="" patient="" co-morbidities,="" discharge="" disposition,="" and="" index="" complications,="" savr="" was="" associated="" with="" a="" significantly="" lower="" readmission="" hazard="" ratio="" (hazard="" ratio="" [hr]="" 0.72,="" 95%="" confidence="" interval="" [ci]="" 0.60="" to="" 0.85,="" p=""><0.001) compared="" with="" tavi="" for="" patients="" with="" ckd1-3.="" this="" association="" was="" not="" significant="" for="" ckd4-5="" (hr="" 0.79,="" 95%="" ci="" 0.58="" to="" 1.07,="" p="0.12)" nor="" esrd="" (hr="" 0.93,="" 95%="" ci="" 0.74="" to="" 1.18,="" p="0.57)">

figure 5

Kev pheej hmoo-kho qhov txawv ntawm kev nyeem ntawv ntxov tau nce siab dua rau TAVI thoob plaws txhua qhovlub raumua tsis tiavpab pawg (Daim duab 6). Txawm tias tom qab tsis suav nrog cov neeg mob rov qab los rau cov pacemaker los yog keeb kwm muaj kev pheej hmoo siab dua rau kev nyeem ntawv xws li cov neeg laus (hnub nyoog siab dua lossis sib npaug ntawm 85, poj niam txiv neej, thiab lub plawv.
tsis ua haujlwm), TAVI cov neeg mob muaj qhov sib txawv siab dua ntawm 30-hnub nyeem ntawv (Ntxiv B). Thaum 90 hnub tom qab tso tawm hauv tsev kho mob, TAVI tau cuam tshuam nrog qhov muaj feem ntau dua ntawm kev nyeem ntawv piv nrog SAVR (Daim duab 7) thaum qhov txawv txav ntawm kev nyeem ntawv nce ntxiv nrog cov kab mob hnyav zuj zus. Cov nqi sib tw txog li 2 qhov kev nkag mus ntsib hauv thawj 90 hnub tom qab tso tawm tau pom tias muaj teeb meem nyiaj txiag ntau dua nrog TAVI tshwj tsis yog rau pawg ESRD (CKD1-3 -$69,442 vs $58,911; CDK4-5 - $77,001 vs $69,062; ESRD2 $85,911 $90,439). Txhua xyoo, kev nyeem ntawv tom qab phais aortic valve hloov pauv tus nqi nruab nrab ntawm 8.6 lab daus las (TAVI $ 6.2 lab, SAVR $ 2.4 lab).

figure 6


figure7

Kev kuaj mob ntsig txog plawv yog qhov laj thawj tshaj plaws rau kev kho mob thoob plaws txhua qhovraumkab mobtheem thiab aortic valve hloov cov txheej txheem. Readmission nyob rau hauv {{0}}}hnub rau lub plawv tsis ua hauj lwm exacerbation yog nquag rau ob qho tib si TAVI thiab SAVR hla CKD Theem 1 txog 5 (4.6 vs 3.6 feem pua, p=0.2) thiab ESRD (4.9 vs 3.1). feem pua ​​, p=0.13). Rau CKD theem 1 txog 3, SAVR cov neeg mob feem ntau tshwm sim nrog arrhythmias (1.4 vs 0.25 feem pua, p=0.004). Txawm li cas los xij, CKD1-3 TAVI cov neeg mob tau nyeem ntau dua hauv 30 hnub rau kev tso pacemaker (1.1 vs 0.16 feem pua, p=0.0001). Hauv qhov sib piv, kev nyeem ntawv rau ischemic lossis hemorrhagic stroke tshwm sim ntau zaus rau TAVI dua li cov neeg mob SAVR ESRD hauv thawj 30 hnub (0.98 vs 0.34 feem pua, p=0.0001).
Txij li thaum nws qhov kev taw qhia thaum xyoo 2011, kev tuag hauv tsev kho mob rau TAVI tau nce mus rau 14 feem pua, tab sis txo qis rau 2.3 feem pua ​​​​hauv xyoo kawg ntawm txoj kev tshawb no (p<0.0001) while="" 30-day="" readmissions="" rates="" remained="" steady="" between="" 23%="" and="" 28%="" (p="0.47)." savr="" in-hospital="" mortality="" (5.1%="" to="" 1.9%,="" p="0.43)" and="" 30-day="" readmission="" rates="" (26.1%="" to="" 31.2%,="" p="0.19)" were="" stable="" during="" the="" study="">

cistanche can treat renal insufficency

Kev sib tham

Muab lawv lub nra ntawm concomitant cardiovascular comorbidities, cov neeg mob uas muaj mob ntev lossis theem kawgraumkab mobsawv cev rau pab pawg tshwj xeeb muaj kev pheej hmoo siab rau SAVR. Cov ntaub ntawv uas twb muaj lawm sib piv cov txiaj ntsig ntawm SAVR thiab TAVI muab cov ntaub ntawv me me hais txog cov txheeb ze zoo ntawm cov qauv no hauv cov neeg mob.lub raumkab mob. Hauv kev tshawb fawb thoob tebchaws no, peb tau ua ntau qhov kev soj ntsuam. Ua ntej, TAVI tau cuam tshuam nrog kev pheej hmoo ntau dua ntawm kev nyeem ntawv piv nrog SAVR rau CKD1-3 cov neeg mob ntawm 30 thiab 90 hnub tom qab tso tawm. Thib ob, thaum SAVR LOS tau ntev dua, nws tau cuam tshuam nrog cov nqi kho mob qis dua rau CKD1-5 thiab ESRD piv nrog TAVI. Thiab thaum kawg, decrements hauvlub raum muaj nuj nqitau cuam tshuam nrog kev tuag zuj zus, thiab cov nqi nce ntxiv, LOS, thiab kev nyeem ntawv hauv ib qib zuj zus.

Ntau pab pawg tau tshuaj xyuas qhov tshwm sim mob hnyav hauv TAVI cov neeg mob thiab pom tias muaj ntau dua ntawm ESRD thiab muaj hnub nyoog nce piv nrog SAVR. Siv cov qauv neeg sawv cev hauv tebchaws, peb pom muaj hnub nyoog zoo sib xws hauv cov pab pawg tab sis ntsib qhov tshwm sim qis dua ntawm ESRD hauv pawg TAVI. Raws li qhov xav tau, cov neeg mob CKD uas tau txais TAVI tau muaj lub nra hnyav ntxiv ntawm cov kab mob sib kis piv nrog SAVR. Qhov no zoo ib yam nrog ntau qhov kev tshawb fawb yav dhau los lees paub qhov sib txawv hauv paus kev sib koom ua ke hauv cov pab pawg,
vim yog txoj kev xaiv. Ua ke, cov txiaj ntsig tsis zoo tau txais nrog TAVI thiab SAVR hauv cov neeg mob siabraumkab mobtej zaum yuav tshwm sim los ntawm qhov sib txawv ntawm cov kev pheej hmoo ntawm cov kab mob sib kis es tsis yog alub raumkab mobrau pom.

Hauv txoj kev tshawb fawb tam sim no, kev pheej hmoo-kho cov neeg tuag tau muaj ntau dua nrog TAVI cov neeg mob thoob plaws txhua theem ntawmlub raumtsis txaus. Cov kev tshawb pom no yog qhov sib txawv nrog kev tsom xam tsis ntev los no-match ntawm 195 tus neeg mob ua khub nrog sib piv Society of Thoracic Surgeons mortality scores thiab glomerular filtration rates, uas qhia tias tsis muaj qhov sib txawv tseem ceeb ntawm TAVI thiab SAVR hais txog kev tuag hauv tsev kho mob, mob raum, lossis qhov xav tau kev lim ntshav.15 Txuas ntxiv qhov kev tshuaj ntsuam no, Korbin li al. pom qhov sib piv 30-hnub kev tuag thiab cov xwm txheej tsis zoo rau cov neeg mob ESRD tau txais TAVI thiab SAVR.16 Txawm hais tias txoj kev tshawb fawb tam sim no raug txwv hauv kev ntsuam xyuas ntawm ntau qhov chaw kho mob, nws muab qhov loj tshaj plaws, tom khw muag khoom nrog TAVI thiab SAVR hauv cov neeg mob.lub raumkab mob, teb chaws. Txawm hais tias siv TAVI-kev pab cuam ntim hauv peb qhov kev tshuaj ntsuam xyuas, peb tsis tuaj yeem txheeb xyuas tus neeg muab kev pabcuam-qib kev paub hauv qhov kev tshawb fawb tam sim no, uas tau pom tias muaj feem cuam tshuam nrog cov txiaj ntsig hauv tsev kho mob.17,18 Txawm li cas los xij, cov neeg mob uas tau txais TAVI thaum lub sijhawm kawm yog feem ntau cov neeg mob uas txwv tsis pub SAVR. Qhov kev xaiv kev kho mob uas muaj peev xwm ua tau, tsis raug kho tag nrho los ntawm kev hloov pauv ntau yam kev pheej hmoo uas siv cov kev tswj hwm kev hloov pauv, tuaj yeem piav qhia txog cov txiaj ntsig kev tuag uas tau pom nyob rau hauv qhov tam sim no.

Piv nrog rau SAVR, TAVI tau ua rau muaj qhov zoo sib xws ntawm qhov ntsuas kev pw hauv tsev kho mob stroke tab sis muaj kev pheej hmoo siab dua ntawm qhov ntsuas pacemaker implantation. Txawm hais tias qhov nce ntawm cov pacemaker implantation nrog TAVI tau raug tshaj tawm yav dhau los, peb qhov kev tshawb pom mob stroke tsis zoo ib yam nrog cov ntaub ntawv.19 Nyob rau hauv sib piv nrog cov kev tsom xam tsis ntev los no, SAVR tau cuam tshuam nrog kev nce ntawm perioperative stroke thiab tag nrho cov neeg tuag. 19 Ntawm qhov kev ceeb toom, qhov kev tshaj tawm no los ntawm Doshi tau tshaj tawm ze li ob npaug ntawm tus nqi pacemaker implantation thaum lub sij hawm qhov ntsuas nyob twj ywm piv nrog rau qhov kev tshawb fawb tam sim no.19 Qhov kev tsis sib haum xeeb no hais txog kev hloov pauv thiab nce tus kab mob stroke tuaj yeem yog vim qhov sib txawv ntawm kev mob thiab kev ua haujlwm, xws li raws li valvular calcification, tsis suav rau hauv kev rov qab los lossis kev sib piv-muab kev tshuaj ntsuam. Kev ywj pheej ntawm txoj hauv kev uas cuam tshuam nrog cov xwm txheej cerebrovascular nce ntxiv, qhov xav tau ntau ntxiv rau kev cog qoob loo pacemaker tom qab TAVI tau tsim tau zoo yav dhau los thiab tau lees paub hauv txoj kev tshawb fawb tam sim no, ua rau muaj kev txhim kho ntxiv ntawm kev xa tawm, kev tso kawm, thiab kev saib xyuas tom qab los tos qhov rov qab los ntawm kev ua haujlwm ntawm lub cev. - system muaj nuj nqi.
Interestingly, ua rau lub raum ua haujlwm tsis zoo ua rau muaj qhov sib txawv ntawm kev nyeem ntawv linearly rau ob pawg SAVR thiab TAVI hauv kev tshawb nrhiav tam sim no. Ntau qhov kev tshawb fawb tau tshuaj xyuas cov txiaj ntsig ntawm kev nyeem luv luv thiab ntev ntev hauv TAVI piv rau SAVR cov neeg mob.20,21 Hannan thiab al pom tias 30-hnub kev nyeem ntawv tus nqi tom qab TAVI thiab SAVR zoo sib xws, txawm tias tom qab kev sib raug zoo.21 Tsis tas li ntawd, ob peb qhov kev tshawb fawb tsis ntev los no tau pom tias muaj kev nce ntxiv thaum ntxov thiab mus sij hawm ntev TAVI morbidity thiab kev tuag nrog kev hnyav zuj zus.lub raumkev ua haujlwm tsis zooTxawm hais tias tsawg tus tau soj ntsuam tshwj xeeb ntawm kev nyeem ntawv raws li spectrum ntawm CKD.22,23 Cov kev tshawb pom no yog qhov sib txawv ntawm peb qhov kev pheej hmoo-hloov kev sib piv ntawm TAVI thiab SAVR readmissions, uas pom muaj feem ntau ntawm kev nyeem ntawv rau TAVI ntau dua li SAVR hauv cov neeg mob uas tsis muaj CKD thiab cov uas muaj CKD1-3.6 Tsis muaj kev koom tes tseem ceeb ntawm TAVI thiab qhov txawv ntawm kev nyeem ntawv hauv CKD4-5 thiab ESRD pawg yuav yog vim muaj qhov piv txwv me me hauv cov pab pawg no thiab kev tswj hwm ntawm CKD{{6} } thiab ESRD dhau ntawm cov txheej txheem hauv kev tswj hwm kev nyeem ntawv. Ntxiv mus, TAVI cov neeg mob hauv txoj kev tshawb fawb tam sim no muaj qhov ntsuas luv luv LOS, qhov tseem ceeb uas yuav ua rau cov pab pawg no nce kev nyeem ntawv.24
Peb txoj kev tshawb fawb muaj ntau yam kev txwv tseem ceeb hauv nws txoj kev rov qab los thiab siv cov ntaub ntawv tswj hwm. Txawm hais tias peb siv cov qauv regression muaj zog los suav cov kab mob hnyav, qhov sib txawv xws li mob plawv tsis ua hauj lwm thiab aortic stenosis, thiab lwm yam, tsis muaj thiab yuav txwv tsis pub siv peb cov txiaj ntsig. Muab hais tias cov lej sib txuas tsis zoo ib yam thoob plaws txhua xyoo ntawm NRD, lub sijhawm ntawm kev taug qab tsuas yog txwv rau cov haujlwm uas tau tshwm sim rau thaum xaus ntawm lub xyoo. Peb kuj tsis tuaj yeem qhia qhov tshwm sim ntawm cov xwm txheej hemorrhagic tom qab kev phais vim muaj qhov xwm txheej tsawg ntawm txhua tuslub raum ua tsis tiavpab pawg. Tsis tas li ntawd, siv cov cai tswj hwm los txiav txim siab ntevraumkab mobes tsis yog kwv yees glomerular filtration, nyiam xaiv cov neeg mob hnyav duaraumkab mobtej zaum tau tshwm sim.

Hauv cov ntsiab lus, kev nyeem ntawv tom qab TAVI thiab SAVR tau pom tias muaj kev nce ntxiv nrog kev nce qib.lub raumkev ua haujlwm tsis zoo. TAVI tau cuam tshuam nrog kev nce ntxiv ntawm kev tuag thoob plaws txhua theem ntawmlub raumua tsis tiavthiab nyeem ntawv tsuas yog rau cov neeg mob nrog CKD1-3. Thiab thaum kawg, qhov nce hauv 90- hnub nyeem ntawv nrog TAVI ua rau muaj kev siv nyiaj ze li $ 6 lab txhua xyoo hauv Tebchaws Meskas.

Cistanche extract

Qhia tawm

Dr. Richard J. Shemin: Tus Kws Pab Tswv Yim rau Edwards Life Sciences Advisory Board, Co-Principal Investigator on PARTNER II Trial. Cov kws sau ntawv ntxiv qhia tsis muaj tswv lossis kev lag luam txaus siab rau ib yam khoom uas tau hais los yog lub tswv yim sib tham hauv phau ntawv no.

Cov khoom siv ntxiv

Cov ntaub ntawv ntxiv uas cuam tshuam nrog cov kab lus no tuaj yeem pom hauv online version ntawm https://doi.org/10.1016/j. hmoob.2019.01.047.


Los ntawm: 'Tshwj xeeb hauv Kev Nyeem Ntawv thiab Nqi Tom Qab Transcatheter Implantation Versus Surgical Aortic Valve Hloov Hauv Cov Neeg Mob Nrog Raum Tsis Ua Haujlwm' los ntawmYas Sanaiha, MD ua al

---The American Journal of Cardiology, 123(9) ISSN 0002-9149 DOI 10.1016/j.amjcard.2019.01.047



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