Björk-Shileyの弁を持つ患者は予防的に置換手術を受けるべきですか?
J D Birkmeyer1, C A Marrin, G T O'Connor
1Program in Medical Information Science, Dartmouth Medical School, Hanover, New Hampshire 03756.
Lancet (London, England)
|August 29, 1992
まとめ
Björk-Shileyコンベックス・コンカヴ (CC) バルブ骨折は致命的なリスクをもたらす. 決定分析は,高リスクの弁を持つほとんどの患者に予防的置換が有益であることを示していますが,年齢と手術リスクは他の人にとって重要です.
科学分野:
- 心血管外科手術についてです.
- バイオメディカルエンジニアリング
- 意思決定 分析 分析
背景:
- Björk-Shileyコンベックス・コンキャブ (CC) 弁は,約8万5千人の患者に使用されている人工心臓弁です.
- これらのバルブには,出口ストラット骨折のリスクがあり,致命的な急性バルブ障害につながる可能性があります.
- ストラット骨折の発生率は,弁の特徴と患者の要因によって異なります.
研究 の 目的:
- CC弁の予防的な再操作から最も恩恵を受ける可能性のある患者を特定するために.
- 意思決定分析を利用して,CCバルブ交換の推奨事項を導き出す.
主な方法:
- バルブ開口の角度,直径,位置によって層格化したストラット骨折発生率の推定.
- マルコフ決定分析モデルを用いて,予防弁置換による寿命と,予防弁置換なしでの寿命を比較する.
- 患者の年齢と手術後の死亡リスクを分析に組み込む.
主要な成果:
- 低ストラット骨折リスクのCCバルブについては,予防的な置換は有益ではありません.
- リスクの高いCCバルブ (例えば,≥29mm,70度) のほとんどの患者は,予防的な置換から利益を得て,寿命を延ばします.
- 高齢者または中等リスクの弁を持つ患者の場合は,手術による死亡リスクと患者の年齢によって決定されます.
結論:
- リスクの高いCCバルブを持つほとんどの患者に予防的な置換が推奨されます.
- 手術後の死亡リスクの個別評価は,CCバルブ置換を検討しているすべての患者にとって不可欠です.
- 患者の年齢と手術リスクは,中等リスクのバルブに関する意思決定の重要な要因です.
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