严重的大动脉狭窄,具有低的横膜梯度和严重的左心室功能障碍:在52名患者的大动脉置换后的结果
H M Connolly1, J K Oh, H V Schaff
1Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.
Circulation
|April 26, 2000
概括
在患有严重左心室功能障碍和大动脉狭窄症的患者中进行大动脉置换可以改善功能状态. 手术后的生存率与年轻的年龄,更大的假肢尺寸和更好的功能级别有关.
科学领域:
- 心脏病学 心脏病学
- 心脏外科手术 心脏外科手术
- 心脏门疾病 心脏门疾病
背景情况:
- 严重的大动脉狭窄,低梯度和左心室功能障碍呈现出复杂的临床情景.
- 在这个特定的患者群体中,大动脉置换 (AVR) 的结果尚未得到充分确立.
研究的目的:
- 评估大动脉置换在患有严重大动脉狭窄,低跨梯度和严重左心室功能障碍的患者的结果.
- 在高风险人群中确定AVR后死亡率和功能改善的预测因素.
主要方法:
- 在1985年至1995年期间,对52名射出分数 (EF) <=35%的患者进行了回顾性分析,这些患者接受了AVR.
- 在62%的患者中,同时进行冠状动脉旁路移植手术.
- 使用单变量和多变量分析来确定死亡率和生存率的预测因素.
主要成果:
- 术后死亡率为21%. 高龄和较小的大动脉假体尺寸预测了医院死亡率.
- 较小的假肢尺寸是手术死亡率的唯一预测因素.
- 大多数患者出现了术后功能改善,74%的患者表现出改善的EF.
- 改善的EF与较小的手术前大动脉面积和女性性别有关.
结论:
- 在患有严重左心室功能障碍和低梯度的患者中,大动脉置换改善了功能状态,尽管手术死亡率增加.
- 手术后的存活率与年轻的患者年龄和较大的大动脉假体尺寸有关.
- 中期生存率受到改善的术后功能阶级的积极影响.
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