手术后的血液动力学参数是否增加了术后大动脉置换术后死亡率的预后价值?
Bart J J Velders1, Michiel D Vriesendorp1, Federico M Asch2
1Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
JTCVS open
|February 29, 2024
概括
术后的血液动力学参数在调整为胸腔外科医生协会预测的死亡风险 (STS PROM) 时,不会显著改善大动脉置换后的死亡预测. STS PROM仍然是患者结果的主要预测因素.
科学领域:
- 心血管外科心血管外科
- 生物医学工程 生物医学工程
- 临床结果研究研究
背景情况:
- 假肢患者不匹配 (PPM) 目前由有效孔径面积 (EOA) 指数值定义.
- 术后血液动力学参数的预后价值超出胸腔外科医生协会预测的死亡风险 (STS PROM) 在大动脉置换后需要进一步调查.
研究的目的:
- 评估术后血动力学参数的预后附加值,以预测大动脉置换后5年全因死亡率.
- 为了确定血液动力学参数是否提供超越STS PROM的增量预测能力.
主要方法:
- 从心脏外科手术大动脉置换 (PERIGON) 关键试验的数据分析,这是一个前性的多中心队列研究.
- 包括1022名通过Avalus生物假体进行大动脉置换的患者.
- 评估候选血液动力学预测因素 (例如,峰值喷气速度,平均压力梯度,EOA指数) 和STS PROM.
- 利用考克斯模型,c统计和净重新分类改进 (NRI) 来评估模型性能.
主要成果:
- 胸部外科医生协会预测的死亡风险 (STS PROM) 是所有原因死亡率的唯一显著的不可变预测因素.
- 将单个或多个术后血液动力学参数添加到STS PROM并没有显著改善预测准确性 (c-统计) 或死亡风险重新分类 (NRI).
结论:
- 胸腔外科医生协会预测的死亡风险 (STS PROM) 是大动脉置换后患者预后的主要决定因素.
- 手术后的血液动力学参数为预测该患者队列所有原因死亡率提供了有限的额外预后价值.
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