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急性逆行型A大动脉剖析的结果,在下降大动脉的入口撕裂
Joon Bum Kim1, Suk Jung Choo2, Wan Kee Kim1
1From the Deparment of Thoracic and Cardiovascular Surgery (J.B.K., S.J.C., W.K.K., H.J.K., S.-H.J., C.H.C., J.W.L.) and Division of Cardiology (J.-K.S.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Circulation
|September 10, 2014
概括
对急性大动脉解剖与向后延伸到上升大动脉的最佳管理尚不清楚. 最初的医疗管理表明,在一些患有逆行型A大动脉剖析的患者中,有希望的长期存活.
科学领域:
- 心血管外科心血管外科
- 胸部外科手术 胸部外科手术
- 血管外科 血管外科
背景情况:
- 对于急性大动脉解剖 (AD) 与从下降大动脉向上升大动脉逆行延伸的最佳管理策略尚未确定.
- 逆行型A型AD在治疗规划和患者治疗结果方面存在独特的挑战.
- 了解预后因素对于指导治疗决策至关重要.
研究的目的:
- 评估急性逆行型A大动脉剖析的医疗与外科治疗的结果.
- 为了比较不同治疗策略之间的长期存活率和大动脉无事件存活率.
- 确定在逆行性AD患者中有利预后的预测因素.
主要方法:
- 对49名患有急性阿尔茨海默病和向后延伸到上升性大动脉的患者 (1999-2011) 的回顾性分析.
- 根据临床稳定性和虚假光线血栓形成,患者被划分为医疗治疗 (MED组,n=16) 和手术治疗 (SURG组,n=33) .
- 应用了治疗意图原则;对所有患者的随访已完成.
主要成果:
- 在MED组中,早期死亡率为0%,在SURG组中为9.1% (P=0.54).
- 与SURG组 (81.2±7.0%),A型AD (74.5±2.8%) 和B型AD (75.3±3.3%) 相比,MED组的五年生存率更高 (100%).
- 在MED (52.7±14.8%) 和SURG (69.6±8.0%) 组 (P=0.98) 之间,五年大动脉无事件生存是可比的.
结论:
- 患有急性逆行型A型AD的患者表现出比患有前期AD的患者更有利的预后.
- 初始的医疗管理,结合必要时及时的干预,可以在选择的A型逆行性AD患者中取得出色的结果.
- 这项研究表明,对于特定的逆行性AD病例,保守的治疗可能是可行的选择.
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