修复与替换的比较在和风湿性关节疾病中的修复与替换
Marek A Deja1, Marcin Malinowski1, Kazimierz Widenka2
1Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland.
The Annals of thoracic surgery
|June 4, 2023
概括
mitra 门的修复提供了改善的存活力,对于类风湿性或化的 mitra 门疾病没有狭窄. 然而,修复对患有额头骨狭窄症的患者没有生存益处,这表明替代可能是相当的.
科学领域:
- 心血管外科心血管外科
- 心脏门疾病 心脏门疾病
- 类风湿性心脏病 类风湿性心脏病
背景情况:
- 对于类风湿性或化关膜疾病的最佳治疗策略,修复与更换,仍然是争论的主题.
- 了解长期结果对于指导临床决策至关重要.
研究的目的:
- 在患有类风湿性或化类风湿性疾病的患者中,比较米特拉 (MV) 修复和更换之间的长期存活率和再操作率.
- 为了研究美肌狭窄症对MV修复与替换的结果的影响.
主要方法:
- 从波兰国家心脏外科手术程序登记处进行了对4338名患者的回顾性分析,这些患者因风湿性或化心脏病而接受了MV修复或替代 (2006-2020年).
- 排除额外复杂手术,重复手术或紧急手术的患者.
- 使用国家卫生基金登记数据分析了长期生存和重新操作的数据,并对修复和替换组进行了比较,包括倾向性得分匹配的队列.
主要成果:
- mitra 门修复证明在没有 mitra 狭窄的患者中改善了存活率 (危险比0.81;P = .022).
- 在患有额头骨狭窄症的患者中,没有观察到对MV修复的显著生存益处 (危险比1.17;P = .332).
- 在狭窄症和非狭窄症组中,在修复和更换之间,无需重新手术的十年自由是可比的,尽管趋势表明狭窄症组中修复后的重新手术率更高.
结论:
- 在没有心肌狭窄的患者中,对风湿性/化心肌膜疾病而言,心肌膜修复是首选的选择,与改善长期存活率有关.
- 如果有额头狭窄,额头修复与替换相比没有生存益处,这表明替换可能是一个更合适的替代方案.
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