まとめ
バルブ再置換は,ニューヨーク心臓協会の機能クラスIVにあり,緊急手術を必要としない限り,最初のバルブ置換と同様の病院内リスクを持っています.
科学分野:
- 心血管外科手術についてです.
- 心臓弁疾患 心臓弁疾患
- 外科手術の結果について
背景:
- 1972年から1981年の間に,1,282件のバルブ交換が行われました.
- 4.5% (58人の患者) は,人工弁内心炎,主弁機能不全,または周弁漏れのために弁の再置換を必要とした.
研究 の 目的:
- 最初の弁置換と比較して,大動脈とミトラル弁の再置換に関連した入院死亡リスクを評価する.
- バルブ再置換を受ける患者の死亡率に影響を与える要因を特定する.
主な方法:
- 1282回の連続したバルブ交換の手続きの遡及的分析.
- 最初のバルブ交換とバルブ再置換の間の死亡率の比較.
- 死亡原因と患者の機能的状態の分析 (ニューヨーク心臓協会のクラス).
主要な成果:
- バルブ再置換による病院内死亡率は14% (8/58) でした.
- ミトラル再置換 (13%) と大動脈再置換 (15%) の死亡率は,初期置換 (それぞれ6.4%と5.2%) よりも高かった.
- すべての死亡は,ニューヨーク心臓協会の機能クラスIVの患者,特に緊急再置換を受けている患者で発生しました.
結論:
- バルブ再置換の入院リスクは,ニューヨーク心臓協会のクラスIVに入っていない患者の初期置換と比較できます.
- 重症患者 (クラスIV) の緊急弁置換は,死亡リスクを大幅に増加させる.
- 義肢弁内心炎,一次弁機能不全,および周弁漏れは,弁の再置換の重要な指標です.
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