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探讨术前并存疾病对接受主动脉瓣置换术患者结局的影响:国际 IMPACT 注册研究的原理与设计。

Impact of pre-existing comorbidities on outcomes of patients undergoing surgical aortic valve replacement - rationale and design of the international IMPACT registry.

机构信息

Division of Cardiac Surgery, Heart Center Siegburg-Wuppertal, University Witten-Herdecke, Ringstr. 49, 53721, Siegburg, Germany.

University Hospital RWTH Aachen, Aachen, Germany.

出版信息

J Cardiothorac Surg. 2021 Mar 25;16(1):51. doi: 10.1186/s13019-021-01434-w.

Abstract

BACKGROUND

Degenerative aortic valve disease accounts for 10-20% of all cardiac surgical procedures. The impact of pre-existing comorbidities on the outcome of patients undergoing surgical aortic valve replacement (SAVR) needs further research.

METHODS

The IMPACT registry is a non-interventional, prospective, open-label, multicenter, international registry with a follow-up of 5 years to assess the impact of pre-existing comorbidities of patients undergoing SAVR with the INSPIRIS RESILIA aortic valve on outcomes. IMPACT will be conducted across 25 sites in Austria, Germany, The Netherlands and Switzerland and intends to enroll approximately 500 patients. Patients will be included if they are at least 18 years of age and are scheduled to undergo SAVR with the INSPIRIS RESILIA Aortic Valve with or without concomitant ascending aortic root replacement and/or coronary bypass surgery. The primary objective is to determine all-cause mortality at 1, 3, and 5 years post SAVR. Secondary objectives include cardiac-related and valve-related mortality and structural valve deterioration including hemodynamics and durability, valve performance and further clinical outcomes in the overall study population and in specific patient subgroups characterized by the presence of chronic kidney disease, hypertension, metabolic syndrome and/or chronic inflammation.

DISCUSSION

IMPACT is a prospective, multicenter European registry, which will provide much-needed data on the impact of pre-existing comorbidities on patient outcomes and prosthetic valve performance, and in particular the performance of the INSPIRIS RESILIA, in a real-world setting. The findings of this study may help to support and expand appropriate patient selection for treatment with bioprostheses.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT04053088 .

摘要

背景

退行性主动脉瓣疾病占所有心脏手术的 10-20%。在接受主动脉瓣置换术(SAVR)的患者中,预先存在的合并症对其结局的影响需要进一步研究。

方法

IMPACT 登记处是一项非干预性、前瞻性、开放性、多中心、国际登记处,随访时间为 5 年,以评估接受 Inspiris Resilia 主动脉瓣 SAVR 的患者预先存在的合并症对结局的影响。IMPACT 将在奥地利、德国、荷兰和瑞士的 25 个地点进行,计划招募约 500 名患者。如果患者年龄至少 18 岁,计划接受 Inspiris Resilia 主动脉瓣置换术,伴或不伴升主动脉根部置换术和/或冠状动脉旁路移植术,则将患者纳入。主要目的是确定 SAVR 后 1、3 和 5 年的全因死亡率。次要目标包括心脏相关和瓣膜相关死亡率以及结构性瓣膜恶化,包括血流动力学和耐久性、瓣膜性能以及总体研究人群和特定患者亚组(伴有慢性肾脏病、高血压、代谢综合征和/或慢性炎症)的进一步临床结局。

讨论

IMPACT 是一项前瞻性、多中心欧洲登记处,将在真实环境中提供有关预先存在的合并症对患者结局和人工瓣膜性能的影响的急需数据,特别是 Inspiris Resilia 的性能。这项研究的结果可能有助于支持和扩大生物假体治疗的适当患者选择。

试验注册

ClinicalTrials.gov 标识符:NCT04053088。

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