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早期手术与无症状非常严重的大动脉狭窄症的常规治疗相比

Duk-Hyun Kang¹, Sung-Ji Park, Ji Hye Rim

¹Division of Cardiac Surgery, Cardiology, Biostatistics, Asan Medical Center, College of Medicine, University of Ulsan, 388-1, Poongnap-dong, Songpa-ku, Seoul, Korea 138-736. dhkang@amc.seoul.kr

|March 24, 2010

概括

对非常严重的大动脉狭窄的早期手术显著改善了无症状患者的长期生存率. 与传统治疗策略相比,这种干预措施降低了心脏病死亡率,提供了更好的治疗选择.

科学领域:

心脏病学心脏病学
心脏外科手术心脏外科手术
膜心脏疾病膜心脏疾病

背景情况:

对于非常严重的大动脉狭窄症无症状患者的手术干预的最佳时间进行了辩论.
这项研究比较了早期手术与传统治疗策略的长期结果.

研究的目的:

评估早期手术干预与非常严重的大动脉狭窄症无症状患者的保守治疗的长期疗效.
评估对整体和心脏病死亡率的影响.

主要方法:

未来包括197名无症状患者,患有非常严重的大动脉狭窄 (大动脉面积≤0.75厘米2,峰值速度≥4.5米/秒或平均梯度≥50毫米).
排除标准包括症状,减少喷射率 (<0.50),显著的额头膜疾病或年龄>85.5岁.
患者被随机分配到早期手术 (n=102) 或常规治疗 (n=95) 中;倾向性得分匹配用于分析.

主要成果:

在早期手术组中没有手术后死亡率.
预计6年心脏病死亡率为早期手术的0%,传统治疗的24% (P<0.001).
估计6年全因死亡率为早期手术的2%,与传统治疗的32%相比 (P<0.001). 倾向性评分分析证实,早期手术显著降低了全因死亡率 (HR 0.135,P=0.008).

结论:

早期手术干预无症状患者,患有非常严重的大动脉狭窄,显著改善长期存活率.
该策略可以降低心脏病死亡率,并且对于手术风险低的患者来说是一个可行的选择.
建议在早期进行手术,以提高这种患者群体的临床结果.

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