在65岁或以上的患者中,对退行性额外外的额外修复与替换
Paul A Kurlansky1, Ernest A Traad2, George Ebra3
1Division of Cardiac Surgery, Columbia University, New York, New York; Center for Innovation and Outcomes Research, Department of Surgery, Columbia University, New York, New York.
The Annals of thoracic surgery
|June 12, 2023
概括
对老年患者来说,米特拉修复比替换提供了持续的生存益处,即使是伴随疾病. 这一终身分析证实,修复是这个人口群体的优越长期选择.
科学领域:
- 心血管外科心血管外科
- 老年医学 老年医学
- 医学成果研究研究成果
背景情况:
- 在老年患者 (≥65岁) 中,米特拉修复与更换的比较生存益处仍然存在争议.
- 退行性心肌膜疾病是一种常见的疾病,需要老年人进行干预.
- 终身分析对于了解这一群体的长期结果至关重要.
研究的目的:
- 在老年患者中,与肌性退行性肌膜疾病的替换相比,对中膜修复的终身存活益处进行调查.
- 为了测试老年人中中枢修复的生存益处在患者一生中持续存在的假设.
主要方法:
- 在1985年至2005年期间,对663名65岁以上的患者进行了回顾性分析,这些患者接受了初级隔离性心肌修复 (n=434) 或更换 (n=229).
- 倾向性得分匹配用于平衡基线特征并减少混变量.
- 分析了长期随访数据,包括长达29年的生存率.
主要成果:
- 匹配分析显示,与更换 (10.9%) 相比,对关膜修复 (3.9%) 的术后死亡率显著降低.
- 在10年和20年的长期生存估计在修复患者 (54.6%和11.0%) 与替代患者 (34.2%和3.7%) 相比显著更高.
- 修复 (11.3年) 的中位生存时间明显长于替换 (6.9年).
结论:
- 在老年患者中,米特拉修复提供了持续的生存优势,而不是替换,无论伴随疾病.
- 这些研究结果支持将米特拉修复作为精选的老年患者患有退行性米特拉疾病的首选手术策略.
- 这一终身分析证实了 mitra 门修复在改善老年人的生存率方面的长期疗效.
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