生物假肢部结构性衰竭的再手术:风险评估
W R E Jamieson1, L H Burr, R T Miyagishima
1University of British Columbia, Vancouver, BC, Canada. wrej@interchange.ubc.ca
Circulation
|September 13, 2003
概括
在较低的纽约心脏协会 (NYHA) 课程中,选择性手术可以降低额头生物假体失败再手术死亡风险. 早期的患者评估使得对生物假体膜恶化的及时,低风险干预成为可能.
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:
- 结构的恶化是生物假体的主要并发症,通常需要重新操作.
- 对于生物假体中枢失效的重新手术具有显著的死亡风险.
- 评估和减轻这些风险对于患者管理至关重要.
研究的目的:
- 为了确定与 mitra 生物假肢失败相关的死亡率.
- 为了确定和评估影响生物假体中失败后重复手术后死亡率的风险因素.
主要方法:
- 追溯分析了1975年至1999年间进行的2,152次双肩生物假肢手术.
- 包括481次用于结构损坏的重新操作.
- 多变量回归分析以确定死亡率的预测因素.
主要成果:
- 整体重新手术死亡率为7.1% (34例死亡).
- 选择性/紧急重复手术的死亡率明显较低 (6.0%),而不是新出现的 (17.8%).
- 随着时间的推移,死亡率下降,在1993-2000年 (3.4%) 期间观察到的最低率.
- 预测因素包括植入/移植时的年龄,紧急情况和NYHA类;然而,对于1993-2000,只有年龄仍然显著.
结论:
- 在低至中 NYHA 功能类型的患者中,通过选择性手术可以降低 mitra bioprosthetic reoperation 死亡率.
- 常规的患者评估有助于更早地进行干预,从而降低了重新手术的风险.
- 优化手术时间和患者选择是改善结果的关键.
相关概念视频
01:27Mitral Valve Prolapse I: Introduction
IntroductionThe mitral valve, one of the heart's four valves, regulates blood flow. These valves have flaps that open and close to direct blood properly through the heart and body. During each heartbeat, the flaps open for blood to pass through and seal shut to prevent backflow. Specifically, the mitral valve opens to allow blood flow from the heart's upper left chamber to the lower left chamber. It then closes securely as the lower left chamber contracts to pump blood to the body, preventing...
01:22Mitral Valve Prolapse II: Assessment and Management
IntroductionA range of clinical features characterizes Mitral Valve Prolapse (MVP), but it is important to note that many individuals with MVP are asymptomatic and may remain so throughout their lives. For those who do exhibit symptoms, the following are the key clinical features:Palpitations: This is a common symptom where individuals feel an irregular or rapid heartbeat. Palpitations in MVP are often due to arrhythmias such as premature ventricular contractions or supraventricular tachycardia.
01:19Mitral Valve Prolapse III: Nursing Management
The nursing management of Mitral Valve Prolapse, or MVP, centers around patient education, symptom monitoring, and lifestyle modifications.Patient Education on MVP Diagnosis and Heredity: Nurses should provide comprehensive education about MVP, a condition where the mitral valve does not close appropriately during heartbeats. This education often includes the condition's pathophysiology, symptoms, and potential complications, like arrhythmias or mitral regurgitation. Though not fully...
01:20Mitral Regurgitation I: Introduction
Mitral regurgitation is characterized by the backward circulation of blood from the left ventricle to the left atrium during systole, a phase of the cardiac cycle when the heart contracts and pumps blood out of the chambers. This abnormal flow occurs primarily due to the dysfunction of the mitral valve or its supporting structures, which include the mitral leaflets, chordae tendineae, annulus, and papillary muscles.Etiology and Mechanisms:Primary Mitral Regurgitation: This type arises from...
01:25Mitral Regurgitation III: Medical Management
Mitral regurgitation (MR) is characterized by retrograde blood circulation from the left ventricle into the left atrium due to inadequate mitral valve closure. The severity of the condition, symptoms, and underlying cause determine treatment strategies.Monitoring and Pharmacological TreatmentPatients with mild to moderate MR typically do not need immediate intervention but regular monitoring to assess progression and guide treatment. Patients with mild MR should have an echocardiogram every 3-5...
01:26Mitral Stenosis III: Medical Management
Mitral stenosis, a condition marked by the narrowing of the mitral valve, necessitates an integrated approach for effective management. This approach includes preventative measures, medical therapy, and surgical interventions to reduce symptoms and prevent complications.PreventionPrevention of mitral stenosis primarily focuses on reducing the incidence of bacterial infections, particularly streptococcal infections, which can lead to rheumatic fever and subsequent valvular damage. Timely...