在肥胖患者中进行最小侵入性大动脉置换的结果:一项倾向匹配研究
Federico Cammertoni1,2, Piergiorgio Bruno1,2, Natalia Pavone1
1Department of Cardiovascular Sciences, Cardiac Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
Brazilian journal of cardiovascular surgery
|March 1, 2024
概括
至少侵入性大动脉置换 (MIAVR) 对肥胖患者来说是安全有效的,与传统方法相比,它提供更快的恢复和更短的重症监护室停留时间. 这种方法改善了呼吸系统的结果,应该考虑这组患者.
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
- 最少侵入性的手术
背景情况:
- 肥胖增加了心脏手术并发症的风险.
- 评估替代性手术方法对于患者的安全性和结果至关重要.
研究的目的:
- 通过肥胖患者的上椎切除术评估微创性大动脉置换 (MIAVR) 的安全性和有效性.
- 在这个特定人群中,将MIAVR与常规的大动脉置换 (CAVR) 相比较.
主要方法:
- 对203名接受选择性大动脉置换的肥胖患者的回顾性审查 (2014年1月至2023年1月).
- 106名MIAVR患者和97名CAVR患者之间的比较.
- 倾向匹配分析创建了两个平衡的91名患者分组,以控制基线差异.
主要成果:
- 在MIAVR和CAVR组之间30天死亡率没有显著差异 (1.1%与0%,P=0.99).
- MIAVR显示出明显更快的输出 (6±2比9±2小时,P<0.01) 和减少了持续正气道压力治疗的需要 (3.3%比13.2%,P=0.03).
- 在MIAVR患者中,重症监护室停留时间较短 (1.8 ± 1.2 vs 3.2 ± 1.4天,P<0.01),长期存活率相似 (逻辑等级P=0.58).
结论:
- 通过上部胸腔切除术进行最小侵入性大动脉置换是肥胖患者的安全有效选择.
- 这种方法在呼吸结果方面提供了显著的好处,包括减少机械通风时间和输出管后支持.
- 较短的重症监护室停留表明MIAVR对肥胖个体有利,并且不应该拒绝这种方法.
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