患有Björk-Shiley门的患者应该进行预防性更换吗?
J D Birkmeyer1, C A Marrin, G T O'Connor
1Program in Medical Information Science, Dartmouth Medical School, Hanover, New Hampshire 03756.
布约克-希利 (Björk-Shiley) 凸凸 (convexo-concave,CC) 门骨折是一个致命的风险. 决策分析表明,预防性替换对大多数高风险门患者有益,但对于其他人来说,年龄和手术风险至关重要.
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
- 决策分析 决策分析
背景情况:
- 伯克-希利 (Björk-Shiley) 凸凸 (CC) 门是一种假体心脏门,在约85,000名患者中使用.
- 这些门存在出口支架骨折的风险,导致潜在致命的急性门故障.
- 支架骨折的发生率因门特征和患者因素而异.
研究的目的:
- 为了确定最有可能从CC门的预防性重新操作中受益的患者.
- 利用决策分析指导CC门更换的建议.
主要方法:
- 估计按门开口角,直径和位置分层的支柱骨折发生率.
- 采用马尔科夫决策分析模型来比较预期寿命与没有预防性门更换.
- 将患者年龄和手术死亡风险纳入分析.
主要成果:
- 预防性更换对于具有较低支架骨折风险的CC门是不有益的.
- 大多数患有高风险CC门的患者 (例如,≥29毫米,70度) 从预防性更换中受益,增加预期寿命.
- 对于老年患者或具有中等风险门的患者,决定取决于手术死亡风险和患者年龄.
结论:
- 建议对大多数患有高风险CC门的患者进行预防性替换.
- 对手术死亡风险的个性化评估对于所有考虑进行CC门置换的患者来说至关重要.
- 患者的年龄和手术风险是决定中等风险门的关键因素.
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