在慢性阶段进行手术治疗,用于没有并发症的斯坦福B型大动脉解剖
Akihito Matsushita1,2, Minoru Tabata3, Takashi Hattori2
1Department of Cardiovascular Surgery, Teikyo University Chiba Medical Center, Chiba, Japan.
PloS one
|February 23, 2024
概括
对于慢性不复杂的B型大动脉剖析,手术方法 (TEVAR,开放修复或药物治疗) 没有影响死亡率. 然而,大动脉直径≥55毫米是增加死亡率的重要预测因素.
科学领域:
- 心血管外科心血管外科
- 血管外科 血管外科
- 主动脉疾病 主动脉疾病
背景情况:
- 讨论了需要干预的慢性无并发型B型大动脉解剖 (UTBAD) 的最佳管理策略.
- 本研究研究了接受大动脉治疗的UTBAD患者的结果,考虑了治疗方式和适应性标准.
研究的目的:
- 评估治疗方法 (TEVAR,开放修复,药物) 对慢性UTBAD患者死亡率的影响.
- 评估特定的适应性标准对UTBAD预后的影响.
主要方法:
- 对106名UTBAD患者 (2004-2021) 的回顾性审查,分为TEVAR,开放修复和药物治疗组.
- 通过晚期手术定义的大动脉事件,直径≥55毫米,快速扩大或囊性动脉瘤.
- 考克斯回归分析用于评估死亡率预测因素.
主要成果:
- 五年死亡率为27.1% (TEVAR),19.6% (开放修复) 和38.4% (药物治疗),没有显著差异 (p=0.86).
- 大动脉直径≥55毫米的患者5年死亡率明显较高 (41.2%对18.7%,p<0.01).
- 多变量分析确定了大动脉直径≥55mm (HR 2.88) 和年龄 (HR 1.09) 作为显著的死亡率预测因素.
结论:
- 目前UTBAD的手术适用性标准并不区分TEVAR,开放修复和药物管理之间的死亡风险.
- 大动脉直径≥55mm是一个关键因素,与UTBAD患者的死亡率增加有关.
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