重度の大動脈吐症と左心室機能の著しく低下した患者の大動脈弁置換後のアウトカム
Hari P Chaliki1, Dania Mohty, Jean-Francois Avierinos
1Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minn 55905, USA.
Circulation
|November 20, 2002
まとめ
重度の大動脈反吐 (AR) と低射出分数 (EF) の患者は,手術リスクが高くなりますが,大動脈弁置換 (AVR) の後に改善されたEFと長期的な生存を経験します. これらの患者は依然としてAVRの恩恵を受けるべきです.
科学分野:
- 心臓病学 心臓病学
- 心臓外科手術について
- 心不全に関する研究
背景:
- 左心室機能不全は,重度の大動脈吐症 (AR) の患者における大動脈弁置換 (AVR) の既知の徴候である.
- AVR後の重度のARと有意に減少したエジェクション分数 (EF) の患者のアウトカムは不明である.
研究 の 目的:
- AVRを受けた重度のARと著しく低いエジェクション分数 (EF) の患者の術後のアウトカムを評価する.
- 術後の死亡率,長期生存率,心不全の発生率を,AVR後の異なるEFグループで比較する.
主な方法:
- 1980年から1995年の間に孤立したARのためにAVRを受けた450人の患者の遡及的分析.
- 患者は,手術前のEFに基づいて3つのグループに分類されました:顕著に低い (LoEF, <35%),中等 (MedEF, 35% - 50%),および正常 (Nl EF, ≥50%).
- 手術後の死亡率,10年生存率,心不全の発生率,および術後のEF変化の比較分析.
主要な成果:
- 運用死亡率は,MedEF (6.7%) とNl EF (3.7%) グループ (P=0.02) に比べて,LoEFグループ (14%) で著しく高かった.
- 10年生存率は,LoEF患者 (41%±9%) とMedEF患者 (56%±5%) とNl EF (70%±3%) 患者 (P<0.0001) の間で低かった.
- 術後のEFは,LoEFとMedEFの両グループで有意に改善したが,Nl EFグループでは減少した.
結論:
- 重度のARと著しく低いEFを経験した患者は,AVR後に手術後の死亡率と長期的な死亡率を増加させ,充血性心不全の割合を高めました.
- 増加したリスクにもかかわらず,術後のEFは顕著な改善を示し,ほとんどの患者は心不全の再発なしに長期的な生存を達成します.
- これらの発見は,重度のARと低EFの患者がAVRの潜在的な恩恵を否定されるべきではないことを示唆しています.
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