早期の手術と,無症状の重度のミトラル吐における従来の治療の比較
Duk-Hyun Kang1, Jeong Hoon Kim, Ji Hye Rim
1Division of Cardiology, Cardiac Surgery, Biostatistics, Asan Medical Center, College of Medicine, University of Ulsan, 388-1, Poongnap-dong, Songpa-ku, Seoul, Korea 138-736. dhkang@amc.seoul.kr
Circulation
|February 4, 2009
まとめ
重度のミトラル反発の早期手術は,保守的な管理と比較して,心臓の死亡率と心不全の入院を大幅に減少させます. この戦略は,心機能が保たれた無症状患者の長期的な結果を改善します.
科学分野:
- 心臓病学 心臓病学
- 心臓外科手術について
- クリニック・トライアル 臨床試験
背景:
- 症状のない重度のミトラル吐における外科介入の最適なタイミングは,依然として不確実です.
- 早期手術と従来の管理戦略の比較が必要である.
研究 の 目的:
- 重度の退行性ミトラル吐と左心房機能の保全を伴う無症状患者の早期の外科介入と保守的な管理の長期的なアウトカムを比較する.
主な方法:
- 1996年から2005年にかけて,重度の退行性ミトラル吐症と左心室機能の保存を有する447人の無症状患者の見通し評価.
- 患者は早期手術グループ (161) と従来の治療グループ (286) に分けられました.
- エンドポイント:手術後の死亡率,心臓発作による死亡率,ミトラル弁の手術を繰り返し,充血性心不全の緊急入院.
主要な成果:
- 1988日間の追跡期間の中央値では,早期手術群では7年の心疾患による死亡率が0%であったが,従来の手術群では5%であった (P=0.008).
- 7年後のイベントフリー生存率は,従来型のグループ (85%) (P=0.007) と比較して,早期手術グループ (99%) で,傾向スコアが一致したペアで有意に高かった.
- 肺高血圧,年齢,および有効な再発性開口部領域は,従来の治療群で遅い出来事を予測しました.
結論:
- 左心室機能が保たれている症状のない重度退行性ミトラル反発の早期手術は,長期的なイベント率の改善と関連しています.
- この戦略は,心臓疾患による死亡率と,充血性心不全による入院数を効果的に削減します.
- 早期の介入は,特にミトラル弁の修復の可能性が高い患者で,臨床結果を改善する可能性があります.
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