大动脉置换后的结果在患有严重大动脉吐和明显降低左心室功能的患者中
Hari P Chaliki1, Dania Mohty, Jean-Francois Avierinos
1Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minn 55905, USA.
Circulation
|November 20, 2002
概括
患有严重的大动脉反 (AR) 和低射出分数 (EF) 的患者面临更高的手术风险,但经历了大动脉置换 (AVR) 后改善的EF和长期存活率. 这些患者仍然应该获得AVR福利.
科学领域:
- 心脏病学 心脏病学
- 心脏外科手术 心脏外科手术
- 心脏衰竭研究研究
背景情况:
- 左心室功能障碍是严重的大动脉反 (AR) 患者的大动脉置换 (AVR) 的已知指示.
- 在AVR后,严重AR和显著降低射出分数 (EF) 的患者的结局仍然不清楚.
研究的目的:
- 为了评估患有严重AR和明显低射出分数 (EF) 的患者的术后结果,接受AVR.
- 在AVR后的不同EF组中比较手术死亡率,长期存活率和心力衰竭发病率.
主要方法:
- 在1980年至1995年期间,对450名接受AVR治疗的患者进行了回顾性分析.
- 根据手术前EF,患者被分为三组:明显低 (LoEF,<35%),中度 (MedEF,35-50%) 和正常 (Nl EF,≥50%).
- 对手术死亡率,十年生存率,充血性心力衰竭发病率和术后EF变化的比较分析.
主要成果:
- 与MedEF (6.7%) 和Nl EF (3.7%) 组相比,LoEF组 (14%) 的操作死亡率明显高 (P=0.02).
- 对于LoEF患者来说,10年生存率较低 (41%±9%) 与MedEF (56%±5%) 和Nl EF (70%±3%) 患者相比 (P<0.0001).
- 在LoEF和MedEF两组中,术后EF显著改善,而在Nl EF组中则下降.
结论:
- 在AVR后,患有严重AR和明显低EF的患者经历了手术后和长期死亡率的增加以及更高的充血性心力衰竭率.
- 尽管风险增加,术后EF显示明显改善,大多数患者实现长期存活,没有心力衰竭复发.
- 这些发现表明,严重AR和低EF的患者不应该被拒绝AVR的潜在益处.
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