大動脈根動脈瘤の手術: 30年間の経験
Kenton J Zehr1, Thomas A Orszulak, Charles J Mullany
1Division of Cardiovascular Surgery, Mayo Clinic, 200 First St SW, Rochester, Minn 55905, USA. zehr.kenton@mayo.edu
Circulation
|August 18, 2004
まとめ
動脈動脈瘤に対する大動脈の根置換は,低死亡率と低罹患率を示しています. 複合弁管と弁の保存再構築の両方とも,耐久的な結果を提供し,弁の故障または他の大動脈の問題に関連した再操作がしばしば行われます.
科学分野:
- 心血管外科手術についてです.
- 胸部外科手術について
- 大動脈外科手術
背景:
- 大動脈の根を巻き込んだ動脈瘤は,外科的介入を必要とします.
- 大動脈の根の置換と弁の保存再建の長期的な結果を評価しています.
研究 の 目的:
- 大動脈の根置換と弁を保持する大動脈の根の再建の長期的な結果を評価する.
- 複合バルブ管とバルブ保存技術の成果を比較する.
主な方法:
- 1971年から2000年の間に大動脈の根の手術を受けた203人の患者の遡及的分析.
- 患者は複合弁管の再建 (149) または弁保存再建 (54) を受けました.
- マルファン症候群は50人の患者に存在していました.
主要な成果:
- 病院内/30日間の死亡率は全体で4.0%で,両処置の死亡率はほぼ同じでした.
- 精算学的生存率は20年後に52%に達し,再手術の必要性のない生存率は20年後に72%であった.
- 遅い死亡の予測要因には,ミトラル吐と高齢化が含まれ,再手術の予測要因には,マーファン症候群と初期弁保存再建が含まれている.
結論:
- 動脈瘤に対する大動脈の根置換は,低罹病率と死亡率で実施できます.
- 複合弁管の再建は,抗凝固薬や義肢弁による合併症が少ない,持続的な結果を提供します.
- 再手術は,大動脈弁の機能不全または他の心臓/大動脈疾患,特に弁保存手術後の再手術がしばしば必要となる.
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