在患有双主动脉的患者中,对外科动脉置换的基准测试结果

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Sameer A Hirji¹, Zachary Wegermann², Sreekanth Vemulapalli²

¹Division of Cardiac Surgery, Brigham & Women's Hospital, Boston, Massachusetts.

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概括

与三动脉患者相比,双动脉患者的外科动脉置换 (SAVR) 在5年内死亡率较低,特别是在低风险个体中. 这一发现有助于将SAVR与用于双主动脉狭窄的跨导管选择进行比较.

科学领域:

心脏病学心脏病学
心脏外科手术心脏外科手术
生物医学工程生物医学工程

背景情况:

关于双主动脉 (AV) 狭窄的最佳治疗方法存在争议:通过导管的大动脉置换 (TAVR) 与手术大动脉置换 (SAVR).
这项研究侧重于与三冠状动脉患者相比,双冠状动脉患者中隔离SAVR的5年纵向结果,特别强调低风险患者群体.

研究的目的:

为了比较隔离SAVR的5年纵向结果,在患有双冠状动脉与三冠状动脉的患者.
为了评估SAVR对双 AV狭窄症低风险患者的死亡率和发病率的影响.

主要方法:

从2011年7月至2018年12月接受隔离指数SAVR的65,687名患者的分析,来源于胸腔外科医生协会 (STS) 成人心脏数据库.
患者被分为两 (n=9131) 和三 (n=56556) 两层,并与Medicare索赔进行综合性结果评估.

主要成果:

与三 AV 患者相比,双 AV 患者年轻,预测死亡风险较低,整体风险概况较低.
风险调整后的30天死亡率和主要发病率在各组之间相似,但风险调整后的5年死亡率在双患者中明显较低 (aHR,0.72).
低风险双患者的5年调整后死亡率显著降低 (aHR,0.69),并降低了心力衰竭,中风和出血的5年再入院风险.

结论:

在双动脉患者中,单独的SAVR与类似的短期结果相关,但与三动脉患者相比,5年死亡率显著降低.
这些发现,特别是在低风险和正常喷射小部分患者中,为为两动脉静脉狭窄的SAVR和TAVR之间的治疗决策提供了关键的国家基准.

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