160人の子供における大動脈弁置換手術のアウトカムと関連するリスク要因:競合するリスク分析
Tara Karamlou1, Karen Jang, William G Williams
1Division of Cardiovascular Surgery, Department of Pediatrics, University of Toronto, The Hospital of Sick Children, Toronto, Canada.
Circulation
|December 1, 2005
まとめ
小児の大動脈弁置換術 (AVR) の後の死亡率と再手術は頻繁です. 若い患者や,バイオプロステスやホモグラフト弁を施す患者は,より高いリスクに直面しています. 肺の自動移植は,よりよい長期的な結果をもたらします.
科学分野:
- 小児心臓外科手術について
- 心血管研究 循環器科の研究
- バイオマテリアル科学 バイオマテリアル科学
背景:
- 子どもにおける大動脈弁置換 (AVR) は,ユニークな課題を提示しています.
- 長期的な結果とリスク要因を理解することは,小児心臓ケアにおいて極めて重要です.
- これまでの研究は,この集団における特定のリスクと利益を完全に明らかにしていない.
研究 の 目的:
- 小児患者のAVR後の患者の特徴,結果,および危険因子を定義する.
- 長期的な死亡率,再手術,再手術なしの生存率を分析する.
- 有害事象に関連する要因を特定し,異なるバルブタイプの影響を評価する.
主な方法:
- 1974年から2004年の間にAVRを受けた子どもの臨床記録の遡及的レビュー.
- 競合するリスクの方法論を適用して,時間に関係するイベントの流行率を決定する.
- 混合線形回帰モデルを用いた縦幅エコーカルディオグラフィのデータ分析.
主要な成果:
- 160人の子どもは198人のAVRを施し,33人の子どもは1回以上の処置を必要とした.
- AVRの10年後の予測結果は,再手術なしの死亡19%,再手術なしの生存率34%,再手術なしの生存率47%でした.
- 死亡の危険因子には,体重の低さ,年齢の若さ,大動脈のアーチの再構築,および非自動移植の使用が含まれています. 再稼働のリスクには,以前の稼働年,バイオプロステス/ホモグラフトバルブが含まれていました.
結論:
- 死亡率と再弁置換の必要性は,小児AVRの後に重大な懸念事項です.
- 年齢の若さやバイオプロステスやホモグラフトバルブの使用は,リスクの増加と関連しています.
- 肺自動移植の使用は,死亡率の低下,グラデントの進行の遅さ,左心室の大きさの縮小を含む利点を示しています.
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