バルブ手術のパターンが変化している
V Rao1, G T Christakis, R D Weisel
1Division of Cardiovascular Surgery, Toronto Hospital, Ontario, Canada.
Circulation
|November 1, 1996
まとめ
大動脈弁 (AVR) とミトラ弁 (MVR) 置換手術を受けた高リスク患者の増加にもかかわらず,アウトカムは安定したままでした. この研究は,これらの複雑なバルブ手術の死亡率や罹患率の有意な上昇を示していません.
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
- 医療技術 医療技術について
背景:
- 手術技術と心筋膜の保護により,大動脈とミトラル弁の手術の結果が改善されています.
- バルブ修理の進歩は,バルブ交換の必要性を減らす.
- バルブ置換を必要とする患者は,往々にして進行した疾患と結石化があり,手術のリスクが高まります.
研究 の 目的:
- 2つの異なる期間間の大動脈 (AVR) とミトラ弁 (MVR) の弁置換の結果を比較する.
- 術後の低出力症候群 (LOS) と手術後の死亡率 (OM) の予測要因を特定する.
- 変化する患者のリスクプロファイルが外科手術の結果に与える影響を評価する.
主な方法:
- トロント病院でAVRまたはMVRを受けた2898人の患者の遡及レビュー.
- 初期の外科グループ (1982年−1986年) と後期の外科グループ (1989年−1993年) の比較.
- LOSとOMの予測要因を決定するための単変数および多変数分析.
主要な成果:
- 後期AVRグループ (n=997) は,早期グループ (n=782) に比べて,より高いリスクの患者が多く,しかしLOS (10%対14%,P=.012) の発生率が低く,同様の手術後の死亡率 (3.4%対3.7%,P=.732) がありました.
- 後期MVRグループ (n=493) にはまた,早期グループ (n=626) と比較して, LOS (19% vs. 21%,P=.361) または OM (5.8% vs. 6.9%,P=.432) で有意な差異がない高リスク患者も多かった.
- 多変量分析は,AVRとMVRの両方の遅いグループにおいて,手術前リスク因子の増加を確認した.
結論:
- AVRおよびMVRを施した高リスク患者の割合が増加しているにもかかわらず,手術後の死亡率と罹患率は著しく増加しませんでした.
- 手術の進歩と術後のケアにより,複雑な弁置換手術のリスクが軽減されているようです.
- 大動脈とミトラ弁の置換のためのアウトカムは,患者の複雑性の進化にもかかわらず,安定しています.
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