在大动脉置换期间治疗中度功能性腹吐:一个队列研究
Xieraili Tiemuerniyazi1, Fei Xu1, Yangwu Song1
1Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 10037 Beijing, China.
Reviews in cardiovascular medicine
|July 30, 2024
概括
对于需要进行大动脉置换 (AVR) 和中度功能性额头吐 (FMR) 的患者,隔离AVR可能比添加额头修复 (MVr) 或更换 (MVR) 更安全. MVR增加了死亡风险,而MVR显示了增加风险的趋势.
科学领域:
- 心血管外科心血管外科
- 心脏门疾病 心脏门疾病
- 手术结果研究研究.
背景情况:
- 在大动脉置换 (AVR) 期间适度功能性腹吐 (FMR) 的最佳手术策略仍在争论中.
- 功能性额头回是接受AVR患者的常见并发症.
- 对并发性FMR的不同手术方法具有潜在的风险和益处.
研究的目的:
- 在接受AVR的患者中,对中度FMR进行三个手术策略的有效性进行比较.
- 评估隔离AVR,伴有 mitra修复的AVR (MVr) 和伴有 mitra置换的AVR (MVR) 对患者存活率的影响.
- 为了确定AVR期间中度FMR的最佳手术管理.
主要方法:
- 在2010年至2019年期间,对468名中度FMR患者进行AVR的回顾性分析.
- 三组的比较:孤立的AVR,AVR + MVr和AVR + MVR.
- 使用卡普兰-梅尔和日志等级测试的生存分析,用于偏差调整的逆概率治疗权重 (IPTW).
主要成果:
- AVR + MVR显示出优异的FMR改善,但与中期死亡率增加有关 (HR: 2.13,p=0.046),在IPTW分析中持续 (HR: 4.15,p=0.002).
- AVR + MVr显示了随访死亡率增加的趋势 (HR: 1.63,p=0.239),在IPTW分析中更为明显 (HR: 2.54,p=0.054).
- 隔离AVR作为对死亡风险进行比较的参考组.
结论:
- 在患有严重的大动脉病和中度FMR的患者中,单独的AVR似乎是一个比AVR与MVR或MVR相结合的更合理的选择.
- 尽管早期的FMR有所改善,但AVR + MVR与较高的死亡风险有关.
- 此外,AVR + MVr可能会增加死亡风险,需要仔细考虑.
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