Yếu tố dự đoán và kết cục ngắn hạn của tình trạng giảm tiểu cầu có ý nghĩa sau thay van động mạch chủ qua ống thông=Predictive factors and short - term outcomes of significant thrombocytopenia after transcatheter aortic valve replacement

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Tác giả: Thị Út Tâm Đỗ, Thị Tâm Lê, Ích Trung Lý, Đinh Trường Duy Nguyễn, Minh Châu Nguyễn, Văn Dương Nguyễn, Thành Nhân Võ

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2024

Mô tả vật lý: tr.161-169

Bộ sưu tập: Báo, Tạp chí

ID: 243651

Thêm vào giỏ

Thay van động mạch chủ qua da là một phương pháp mới có hiệu quả và ít xâm lấn để điều trị hẹp van động mạch chủ. Mặc dù tỉ lệ thành công cao nhưng vẫn có một vài biến chứng, trong đó giảm số lượng tiểu cầu trong thời gian nằm viện dường như làm tăng nguy cơ tử vong trên bệnh nhân sau thay van động mạch chủ qua da. Tại Việt Nam, tỉ lệ giảm tiểu cầu sau thủ thuật và mối liên quan của giảm tiểu cầu đến kết cục lâm sàng sau thay van động mạch chủ qua ống thông (TAVR) vẫn còn thiếu dữ liệu. Mục tiêu: Xác định yếu tố dự đoán và kết cục ngắn hạn của tình trạng giảm tiểu cầu sau thay van động mạch chủ qua ống thông. Đối tượng và phương pháp nghiên cứu: Nghiên cứu đoàn hệ hồi cứu kết hợp tiến cứu, có theo dõi dọc trên 80 bệnh nhân hẹp van động mạch chủ nặng, được thay van qua ống thông tại Bệnh viện Vinmec Central Park từ tháng 3/2017 đến 8/2023. Chúng tôi ghi nhận thông tin bệnh nhân, thông tin thủ thuật và ghi nhận biến chứng sau thủ thuật. Kết quả: Trong số 80 bệnh nhân với độ tuổi trung bình là 70,5 ± 8,6 với nam giới chiếm 53,7%. Đa số bệnh nhân thay van có nguy cơ phẫu thuật trung bình chiếm 81,5%. Chúng tôi ghi nhận tỉ lệ giảm tiểu cầu có ý nghĩa là 17,5%, tiểu cầu giảm thấp nhất vào ngày thứ 3 sau thủ thuật và hồi phục hoàn toàn vào ngày thứ 30. BMI thấp là yếu tố nguy cơ độc lập dự báo giảm tiểu cầu có ý nghĩa sau thay van động mạch chủ. Đối với những bệnh nhân giảm tiểu cầu có ý nghĩa sau thủ thuật ghi nhận có tỉ lệ biến chứng chảy máu đe doạ tính mạng, tỉ lệ biến chứng mạch máu lớn và tỉ lệ tử vong sau xuất viện 30 ngày cao hơn đáng kể so với nhóm không giảm tiểu cầu. Giảm tiểu cầu sau thủ thuật thay van động mạch chủ qua da có giá trị dự báo kết cục lâm sàng bất lợi tại thời điểm 30 ngày sau thủ thuật tốt với OR = 4,3. Kết luận: Giảm tiểu cầu sau thay van động mạch chủ qua da khá thường gặp và là yếu tố mạnh có giá trự dự báo kết cục lâm sàng bất lợi tại thời điểm 30 ngày sau thủ thuật.Transcatheter aortic valve replacement is a new, effective, and minimally invasive method for treating aortic stenosis. Despite a high success rate, there are some complications, among which a reduction in platelet count during hospitalization appears to increase the risk of mortality in patients after the procedure. In Vietnam, data on the rate of thrombocytopenia after the procedure and its correlation with clinical outcomes following transcatheter aortic valve replacement are still lacking. Objective: Identifying Predictive Factors and Short-Term Outcomes of Thrombocytopenia Following Transcatheter Aortic Valve Replacement. Methods: This study utilized a combined retrospective and prospective cohort design, longitudinally monitoring 80 patients with severe aortic stenosis who underwent transcatheter aortic valve replacement at Vinmec Central Park Hospital from March 2017 to August 2023. We recorded patient demographics, procedural details, and documented complications following the procedure. Results: Among the 80 patients, the average age was 70.5 ± 8.6, with males constituting 53.7%. The majority of the patients undergoing valve replacement, accounting for 81.5%, were classified as having a moderate risk of surgical complications. We observed a significant rate of thrombocytopenia at 17.5%, with the lowest platelet counts recorded on the third day post-procedure and full recovery by day 30. A low BMI was identified as an independent risk factor for significant thrombocytopenia after aortic valve replacement. Patients experiencing significant thrombocytopenia post-procedure exhibited higher rates of life-threatening bleeding, major vascular complications, and significantly increased 30-day post-discharge mortality compared to those without TAVR proved to be a strong predictor of adverse clinical outcomes at 30 days post-procedure, with an odds ratio of 4.3. Conclusion: Thrombocytopenia following transcatheter aortic valve replacement is relatively common and serves as a strong predictive factor for adverse clinical outcomes 30 days post-procedure.

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