在患有严重大动脉狭窄症的无症状患者中进行大动脉置换的概念不断发展
Hoda Javadikasgari1, Siobhan McGurk1, Paige C Newell1
1Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
The Annals of thoracic surgery
|September 3, 2023
概括
在无症状的严重大动脉狭窄症 (AS) 中,早期手术性大动脉置换 (SAVR) 改善了生存率和左心室质量. 然而,在手术前中度至重度的左心室缩与生存惩罚有关.
科学领域:
- 心脏病学 心脏病学
- 心脏外科手术 心脏外科手术
- 心声回声扫描 (Echocardiography) 是一种心声回声扫描.
背景情况:
- 无症状严重的大动脉狭窄症 (AS) 管理正在发展,试验表明早期手术大动脉置换 (SAVR) 的生存益处.
- 这项研究调查了SAVR在无症状严重AS患者的长期临床和心声学结果.
研究的目的:
- 分析无症状重症大动脉狭窄症 (AS) 中手术大动脉置换 (SAVR) 的长期临床和心声学结果.
- 评估手术前左心室缩 (LVH) 和腹功能障碍对SAVR后生存的影响.
主要方法:
- 对272名无症状重症AS患者进行SAVR (2002-2020年) 后期分析.
- 在平均8.5年的随访期间,使用心声谱对左心室质量指数 (LVMI) 和E/E'进行纵向评估.
- 考克斯比例危险模型用于评估术前LVMI和E/E'与生存的关联.
主要成果:
- 没有手术死亡率;15年生存率为76%,与一般人群相比.
- 在患有中度/重度手术前左心室缩 (LVH) 的患者中,LVMI 在SAVR后得到改善.
- 在呈现时中度至重度的LVH独立地与生存惩罚相关 (HR,2.32;P=.045).
结论:
- 在无症状的严重AS中,SAVR恢复了生存率并改善了LVH,但可能无法解决持续的扩张功能障碍.
- 在显著的LVH发生之前支持早期SAVR,以避免生存处罚.
- 需要进一步的研究,才能充分理解SAVR后的透缩功能障碍的长期影响.
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