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机械或生物假体用于45岁至74岁的患者的大动脉置换

Daokun Sun¹, Hartzell V Schaff¹, Kevin L Greason¹

¹Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.

The Journal of thoracic and cardiovascular surgery

|July 3, 2024

概括

对于手术更换大动脉,机械在70岁或更年轻的患者中比生物假体提供更好的长期存活率. 在选择机械假肢和生物假肢时,患者应被告知这种生存益处.

科学领域:

心血管外科心血管外科
生物材料科学生物材料科学
临床结果研究研究

背景情况:

在手术上更换大动脉 (SAVR) 的生物和机械假肢之间做出选择是一个复杂的临床决定,正在进行辩论.
比较这些假肢类型的长期结果对于指导患者选择和改善外科手术实践至关重要.

研究的目的:

为了比较患者的长期存活率和并发症率进行SAVR与生物或机械大动脉假肢.
评估假肢类型对患者长期生存的年龄相关影响.

主要方法:

对5762名年龄在45-74岁之间的患者进行了回顾性分析,这些患者在1989年至2019年期间接受了SAVR.
利用考克斯的比例危险模型来比较晚期存活率,并评估了年龄与假肢类型的相互作用.
评估中风,严重出血和对大动脉假肢的重新手术的发生率.

主要成果:

总体而言,61%的患者接受了生物假体;30天死亡率在各组之间相似 (1.7%对1.5%).
在平均9.0年的随访期间,生物假体与更高的调整后死亡风险相关 (HR 1.30,P < .001).
与生物假体相比,机械门显示了高达70岁的生存益处,具有类似的中风风险,较低的出血风险和较高的重新手术风险.

结论:

与生物假体相比,机械大动脉与70岁或更年轻的患者的长期死亡风险调整后的降低有关.
70岁以下接受SAVR治疗的患者应接受有关机械门假肢的生存优势的咨询.

关键词:

大动脉门更换术生物的生物的生物的生物.机械机械机械机械机械

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