在失败的左心室中更换大动脉:值得吗?
Asanish Kalyanasundaram1, Thais Faggion Vinholo1, Mohammad A Zafar1
1Aortic Institute at Yale-New Haven Hospital, New Haven, CT 06510, USA.
Reviews in cardiovascular medicine
|July 30, 2024
概括
手术性大动脉置换 (SAVR) 对于患有严重大动脉狭窄或吐以及低射出率 (EF) 35%或以下的患者是安全的. 随着时间的推移,SAVR显著改善了EF,生存率与一般人群相比.
科学领域:
- 心血管外科心血管外科
- 心脏门的修复和更换
- 心声回声扫描 (Echocardiography) 是一种心声回声扫描.
背景情况:
- 目前的指导方针建议在严重的大动脉狭窄或吐时进行大动脉置换 (AVR),无论左心室喷射率 (LVEF) 是多少.
- 然而,外科医生可能会犹在患有非常低LVEF (<55%) 的患者中进行SAVR,因为他们认为手术风险很高.
- 这项研究调查了严重受损LVEF (≤35%) 的患者SAVR的结果.
研究的目的:
- 评估手术大动脉置换 (SAVR) 的安全性和有效性,用于严重减少左心室喷射率 (LVEF ≤35%) 的患者.
- 在这个高风险患者群体中评估SAVR后的LVEF和中期存活率的变化.
主要方法:
- 在2004年至2019年间对895名接受SAVR治疗的患者进行了回顾性分析,确定了40名LVEF≤35%的患者.
- 使用术前和术后心声图来评估LVEF的变化.
- 动脉内气球 (IABP) 用于18名患者的预防;分析了中期存活率.
主要成果:
- 住院生存率高达97.5%,高达97.5%.
- 平均LVEF从手术前的26%显著改善到中期随访 (平均43个月) 的46%.
- 五年生存率与年龄和性别匹配的普通人口相比,左心室尺寸显著减少.
结论:
- 在左心室受损 (LVEF ≤ 35%) 和严重的大动脉膜疾病的患者中,SAVR可以安全地进行.
- 患者在SAVR后的LVEF显著改善,导致长期生存正常化.
- 在这种群体中,IABP的预防性使用可能是有益的,外科医生不应该在这些患者中避免SAVR.
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