高齢者における大動脈弁置換と併発したミトラ弁の嘔吐:生存と機能的結果への影響
Christopher J Barreiro1, Nishant D Patel, Torin P Fitton
1Division of Cardiac Surgery, The Johns Hopkins Medical Institution, Baltimore, MD 21287, USA.
Circulation
|September 15, 2005
まとめ
適度なミトラル反発 (MR) は,大動脈弁置換手術 (AVR) を受けている高齢患者の長期的な生存に著しく影響を与えます. 同時にミトラバルブ手術を行うことは,内在的なミトラバルブ病を患っている人にとって有益である可能性があります.
科学分野:
- 心血管外科手術についてです.
- ゲリアトリック心臓病学
- バルブ性心疾患 バルブ性心疾患とは
背景:
- 隔離性大動脈弁置換 (AVR) を受けている高齢の患者におけるミトラル反吐 (MR) の効果については,さらなる説明が必要である.
- この集団における生存率と機能的アウトカムに対する術前中度型MRの影響はよく定義されていません.
研究 の 目的:
- 隔離型AVRを受けた高齢患者の生存および機能的アウトカムに対する術前中度型MRの長期的な影響を調査する.
- この患者集団における中程度のMRに関連した危険因子およびアウトカムを特定する.
主な方法:
- 408人の高齢患者 (>=70歳) の遡及レビュー.
- 術前エコーカルジオグラムに基づいて,無/軽度MR (グループI) と中度MR (グループII) に分層する.
- 短いフォーム12アンケートを使用して,長期的な生存と機能的アウトカムの評価.
主要な成果:
- 適度なMRは,長期的な生存率の低下 (P=0.04) の独立した危険因子として特定されました.
- 10年生存率は,グループによって有意に異なる (軽度MRでは40.1%,中度MRでは14.6%).
- 機能的なMRはAVR後に改善したが,内在的なMRはしばしば持続または悪化し,グループ間の機能的結果が類似した.
結論:
- 適度なミトラル反発は,孤立したAVRを受けた高齢者の長期的な生存率の低下の独立した予測因子です.
- AVRを患っている内在的なミトラバルブ疾患の患者には,同時にミトラバルブ手術を検討することが推奨されます.
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