高齢者におけるミトラル義肢の選択. 実際の結果を分析する
E A Grossi1, A C Galloway, P K Zakow
1Department of Surgery, New York University Medical Center, NY 10016, USA. grossi@cv.med.nyu.edu
Circulation
|December 16, 1998
まとめ
弁置換手術を受ける高齢者の場合,実際の分析では,バイオプロテスおよび機械的プロテスに対して,リスクを過大評価する精算分析とは異なり,弁の変性および合併症から同様の自由性が示されています.
科学分野:
- 心臓病学 心臓病学
- 心臓外科手術について
- バイオメディカルエンジニアリング
背景:
- 機械義肢 (MP) は,生体義肢 (BPs) の変性によるミトラ弁置換 (MVR) の若い患者において好ましい.
- 高齢の患者は,非心臓発作による死亡 (NCD) のような競合するリスクに直面し,バルブ選択のリスク・利益を潜在的に変化させる可能性があります.
- アクチュアル分析は,死亡率を考慮しないことで,高齢者の弁変性リスクを過大評価しています.
研究 の 目的:
- バルブ変性 (VD) の欠如に関する精算学的および累積的発生率 (実際の) 分析を,MVRを施した高齢の患者で比較する.
- 70歳以上の患者で,バイオプロステスによる対メカニカルミトラ弁置換の長期的なアウトカムを評価する.
主な方法:
- 1976年から1996年の間にMVRを受けた70歳以上の504人の患者の遡及的分析.
- バルブ変性 (VD) とバルブ関連合併症 (VRC) の10年無症候群の比較は,精算法と実際の (累積的発生率) 方法の両方を用いて行われました.
- プロテスのタイプによるアウトカムの分層化:バイオプロテシス (BP) 対 機械的プロテシス (MP).
主要な成果:
- 病院での死亡率は,BP (15.9%) とMP (18.5%) の間で比較可能でした.
- VDからの10年間の実際の自由は,BP (92.6%) とMP (95.4%) の両方にとって高いものでした.
- すべてのVRCから10年間の実際の自由度も同様でした:BPでは84.4%,MPでは92.3%でした.
結論:
- 精算学的分析は,実際の分析と比較して,高齢のMVR患者における10年間の静脈疾患のリスクを大幅に過大評価しています.
- 高齢者の患者では,VDとVRCsからの実際の自由は,バイオプロステティックと機械弁の間で有意に異なります.
- 高齢者における義肢の選択は,弁の変性リスクよりも,抗凝固要求などの要因に左右される可能性があります.
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