160名儿童的大动脉置换的结果和相关风险因素:竞争风险分析
Tara Karamlou1, Karen Jang, William G Williams
1Division of Cardiovascular Surgery, Department of Pediatrics, University of Toronto, The Hospital of Sick Children, Toronto, Canada.
Circulation
|December 1, 2005
概括
在小儿主动脉置换 (AVR) 后,死亡率和重新手术是常见的. 年轻患者和接受生物假体或同种植门的患者面临更高的风险. 肺部自体移植提供更好的长期结果.
科学领域:
- 儿科心脏手术 儿科心脏手术
- 心血管研究研究心血管研究
- 生物材料科学 生物材料科学
背景情况:
- 在儿童中,大动脉置换 (AVR) 带来了独特的挑战.
- 了解长期结果和风险因素对于儿科心脏护理至关重要.
- 之前的研究还没有完全阐明这一群体的特定风险和益处.
研究的目的:
- 在儿科患者中定义AVR后的患者特征,结果和风险因素.
- 分析死亡的长期发病率,重新手术和没有重新手术的生存率.
- 为了确定与不良事件相关的因素,并评估不同门类型的影响.
主要方法:
- 对1974年至2004年间接受AVR的儿童的临床记录的回顾性审查.
- 应用竞争风险方法来确定与时间相关的事件发生率.
- 使用混合线性回归模型进行纵向心声图数据分析.
主要成果:
- 160名儿童接受了198次AVR;33人需要进行一次以上的手术.
- 在AVR后的10年,预测结果是:19%的死亡没有重新手术,34%的重新手术和47%的生存没有重新手术.
- 死亡的危险因素包括体重较低,年龄较小,大动脉门重建和非自动移植的使用. 重新操作的风险包括之前的运营年和生物假体/同种植门.
结论:
- 儿科AVR发生后,死亡率和需要重复门更换的需要是严重的担忧.
- 年龄较小和使用生物假体或同种植门与风险增加有关.
- 肺部自移植的使用证明了益处,包括降低死亡率,缓慢的梯度进展和较小的左心室尺寸.
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