在之前的心血管手术后,重新手术的整体门置换:连续426名患者的结果
Eilon Ram1, Christopher Lau2, Arnaldo Dimagli2
1Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
The Journal of thoracic and cardiovascular surgery
|September 1, 2023
概括
再手术全动脉门置换 (TAR) 在技术上具有挑战性,与首次TAR相比,导致更高的手术死亡率和不良事件. 仔细规划和末端器官保护对于在这些复杂的案例中获得更好的结果至关重要.
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
- 大动脉外科手术
背景情况:
- 整体大动脉门置换 (TAR) 越来越多地进行,即使在患者之前有心血管手术.
- 再操作性 TAR 具有独特的技术挑战,并有可能增加发病率和死亡率.
研究的目的:
- 为了比较重新手术全动脉门置换 (reop TAR) 与第一次TAR的结果.
- 确定与之前心血管手术患者的再手术ART相关的风险和益处.
主要方法:
- 在1997年至2022年期间接受TAR治疗的426名患者的回顾性分析.
- 患者被分为两组:重复手术TAR (n=150) 和第一次TAR (n=276).
- 分析了包括手术死亡率,主要不良事件,长期存活率和重新干预率在内的结果.
主要成果:
- 重复手术的TAR组的手术死亡率明显较高 (3.3%与0.4%相比),主要不良事件的风险增加了4倍.
- 重复手术的TAR队列中,10年生存率较低 (76%vs82.2%),晚期重复干预的需要更大.
- 重复手术的患者出现了更多的并发症,包括缺血性心脏病,以前的中风和功能障碍.
结论:
- 再操作性TAR与增加的操作性死亡率和不良事件有关,这强调了它的技术复杂性.
- 精确的外科规划和专注的末端器官保护对于在重复手术时取得令人满意的结果至关重要.
- 需要进一步的研究来确定可能受益于更积极的初步程序的高风险群体,以减少迟到的重新干预.
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