存活率损失与指导方针为退行性 mitrale 排泄手术的指导方针相关
David Vancraeynest1, Anne-Catherine Pouleur1, Christophe de Meester1
1Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, and IREC/CARD UCLouvain, Av Hippocrate 10/2806, B-1200 Brussels, Belgium.
European heart journal. Cardiovascular Imaging
|July 12, 2024
概括
在退行性 mitrale regurgitation (DMR) 患者中等待基于指南的手术触发器与减少生存时间有关. 建议早期进行手术,以改善DMR患者的治疗结果.
科学领域:
- 心血管外科心血管外科
- 心脏外科手术 心脏外科手术
- 中心门疾病的疾病.
背景情况:
- 目前针对重症退行性额回 (DMR) 的操作指南是基于ACC/AHA或ESC/EACTS的建议.
- 关于最佳手术时间及其对DMR手术后长期生存的影响存在不确定性.
研究的目的:
- 调查是否遵守基于指南的DMR手术指示与晚期术后生存损失有关.
- 评估不同手术触发器类对患者结果的影响.
主要方法:
- 分析了2833名经过DMR外科纠正的患者,这些患者来自Mitral Regurgitation国际数据库注册表.
- 根据手术指示对患者的分层:I类,孤立的IIa类,或没有触发.
- 使用受限平均生存时间 (RMST) 分析和临床差异匹配后的危险比率对术后生存率的比较.
主要成果:
- 与IIa类或没有触发器相比,为I类触发器进行手术的患者的长期存活率明显较低 (分别为71.4%和84.3%和88.9%在10年).
- 一类触发因素与过度死亡率相关 (P < 0.001),多个I类标准增加死亡风险 (HR: 1.53).
- 单独的IIa类触发因素也增加了死亡风险 (HR:1.46,P = 0.05),单独的肺高血压或心房动与生存率下降有关.
结论:
- 在I类或单独的IIa类触发物显现之前,推迟对退行性额回的手术与显著的术后生存损失有关.
- 这些发现支持对严重DMR患者的早期手术干预策略,以改善长期存活率.
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