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假肢患者不匹配会影响主动脉替换后的生存率

V Rao¹, W R Jamieson, J Ivanov

¹Division of Cardiovascular Surgery of Toronto General Hospital, Toronto, Ontario, M5G 2C4, Canada.

|November 18, 2000

概括

假肢-患者不匹配,以小有效孔面积与身体表面积的比率来定义,增加了大动脉置换后的死亡率. 仔细选择假肢对于改善患者存活率和减少门相关死亡至关重要.

科学领域:

心血管外科心血管外科
生物医学工程生物医学工程
临床结果研究研究

背景情况:

传统上,外科医生避免使用小主动脉假体,因为他们担心左心室外流通道阻塞和跨膜梯度.
假肢-患者不匹配,假肢的大小不适合患者的身体大小,是大动脉置换 (AVR) 的一个重大问题.

研究的目的:

为了调查假肢患者不匹配对AVR后长期存活的影响.
确定有效孔径面积与身体表面积 (EOA/BSA) 的比率与患者结果之间的关系.

主要方法:

对2981名使用支架生物假体进行AVR的患者 (1976-1996) 的回顾性分析.
对2154名患者的EOA/BSA比率的计算,以定义一个"小"组 (<0.75厘米/米2) 和一个对照组 (>0.75厘米/米2)).
使用考克斯回归分析的组之间的手术死亡率,长期存活率和无门相关死亡率的比较.

主要成果:

"小"组 (EOA/BSA <0.75 cm(2) /m(2)) 经历了更高的手术死亡率 (8%与5%相比,P=0.03).
12年的精算生存率相似 (50%对49%,P=0.27),但在"小"组中,没有门相关死亡率显著较低 (75%对84%,P=0.004).
高龄和EOA/BSA<0.75厘米/m2是门相关死亡率的预测因素.

结论:

假肢患者不匹配导致生物假肢AVR后的早期和晚期死亡率增加.
建议EOA/BSA比率大于0.75厘米/米,以避免阻塞和梯度.
仔细的假肢-患者匹配对于改善AVR后的存活率至关重要.

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