在低风险患者手术大动脉置换后的生存率:当代试验基准
Vinod H Thourani1, Robert Habib2, Wilson Y Szeto3
1Department of Cardiothoracic Surgery, Piedmont Healthcare, Atlanta, Georgia.
The Annals of thoracic surgery
|October 20, 2023
概括
手术大动脉置换 (SAVR) 在低风险患者中显示出优异的长期存活率,预测风险低或年龄较小的患者的8年存活率达到95%. 这些发现支持SAVR作为严重的大动脉狭窄的可行选择.
科学领域:
- 心脏病学 心脏病学
- 心脏外科手术 心脏外科手术
- 医学结果的医学结果.
背景情况:
- 在低风险患者中严重的大动脉狭窄症的管理正在发展.
- 通过导管的大动脉置换 (TAVR) 需要与手术大动脉置换 (SAVR) 进行比较.
- 关于SAVR结果的真实,长期数据对于临床决策至关重要.
研究的目的:
- 评估当代的长期,在低风险患者手术大动脉置换 (SAVR) 的现实世界结果.
- 为了提供一个比较SAVR与跨导管大动脉置换 (TAVR) 的基准.
- 为了为患有严重大动脉狭窄症的患者提供临床决策信息.
主要方法:
- 从胸部外科医生协会 (STS) 数据库 (2011-2019) 中分析了42 586名接受初级隔离SAVR的患者.
- 包括/排除标准反映了PARTNER 3和Evolut低风险试验.
- 卡普兰-梅尔法用于估计未调整的全因死亡存活率到8年,按STS预测的死亡风险 (PROM),年龄和射出分数分层.
主要成果:
- 整体8年生存率为92.9%,5年死亡率为12.4%,8年死亡率为12.4%.
- 对于较低的STS PROM,较年轻的年龄和较高的射出分数 (P < .001对所有人来说),生存率明显更好.
- 患有STS PROM<1%或年龄<75岁的患者,8年生存率为95%.
结论:
- 当代SAVR在低风险患者中显示出优异的长期存活率.
- 纵向数据支持SAVR作为严重的大动脉狭窄的持久治疗方法.
- 结果有助于解释TAVR与SAVR试验,并指导低风险个体的临床选择.
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