经过或没有同时冠状动脉旁路移植进行大动脉置换的八胞胎患者的长期存活率:一个22年的三级单中心经验
Hannah Masraf1, Davorin Sef1, Sirr Ling Chin1
1Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton SO16 6YD, UK.
Journal of clinical medicine
|July 29, 2023
概括
将冠状动脉旁路移植 (CABG) 添加到八岁以上人群中的大动脉置换 (AVR) 并没有影响长期存活,但增加了住院死亡率. 心脏团队的讨论对于这些复杂的病例至关重要.
科学领域:
- 心脏病学 心脏病学
- 心脏外科手术 心脏外科手术
- 老年医学 老年医学
背景情况:
- 结合冠状动脉绕道移植 (CABG) 与大动脉置换 (AVR) 在老年患者 (八分生) 中的必要性和影响仍然是持续辩论的主题.
- 这项研究调查了接受隔离AVR和接受AVR和CABG的八十岁人群的特征和长期生存结果.
研究的目的:
- 为了比较经过隔离性大动脉置换 (AVR) 的八岁以上患者的长期生存和术后结果,与接受AVR与冠状动脉旁路移植 (CABG) 结合的患者进行比较.
- 确定两组死亡率的预测因子,并评估同时使用CABG是否独立影响长期存活率.
主要方法:
- 在2000年至2022年期间在第三级心脏中心接受AVR的八十岁患者的回顾性分析,包括或不包括CABG.
- 排除重复手术,急诊手术或其他并发手术的患者.
- 主要终点包括30天和长期生存;次要终点包括早期术后结果和生存决定因素,使用后勤和考克斯回归模型进行分析.
主要成果:
- 总共有1011名患者接受了孤立的AVR,1055人接受了AVR + CABG. 两组的30天和长期生存率在两组之间是可比的.
- 术后平均存活时间相似 (7.1年为AVR,6.6年为AVR + CABG; p=0.21).
- 同时使用CABG并不是不利的长期生存的独立预测因素 (HR:0.89;p=0.09),尽管它与更高的住院死亡率有关.
结论:
- 在八十岁的人中,将CABG添加到AVR中并没有显著改变长期生存结果.
- 接受AVR + CABG的八分生殖器人与接受孤立AVR的人相比,在医院内死亡率更高.
- 对这些患者的个性化治疗决定应该通过彻底的心脏团队咨询来做.
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