大动脉年扩大与隔离性大动脉置换在匹配年的患者中
Alexander Makkinejad1, Katelyn Monaghan2, Sarah A Chen3
1Department of Surgery, UF Health, University of Florida, Gainesville, Florida.
The Annals of thoracic surgery
|August 5, 2024
概括
大动脉环形扩大可能有利于小大动脉环形患者进行大动脉置换 (AVR). 这种程序改善了中期存活率,并减少了患者与假肢的不匹配,证明了对死亡的保护.
科学领域:
- 心血管外科心血管外科
- 心脏门手术 心脏门手术
- 大动脉门的更换
背景情况:
- 小的本土大动脉环 (≤23毫米) 在大动脉置换 (AVR) 中带来了挑战.
- 大动脉环状扩大 (AAE) 对这些患者中期结果的影响尚未完全理解.
研究的目的:
- 为了评估AAE对中期结果的影响,患者接受了与小本源大动脉环形患者隔离的AVR.
- 使用倾向性得分匹配来比较AVR与AAE之间的结果.
主要方法:
- 对1328名从2011年至2022年接受隔离AVR的患者进行了回顾性分析.
- 1163名患者没有AAE (AVR组) 和165名患者有AAE (AVR+AAE组).
- 倾向性得分匹配创建了112对对照,以控制基线特征和圆环大小.
主要成果:
- 在这两组中,环状体的中位尺寸为23毫米;在AVR+AAE组中,假肢尺寸更大 (25毫米对23毫米).
- AVR+AAE组显示显著改善了6年生存率 (98%vs74%) 并与死亡率降低独立相关 (HR 0.19).
- 操作死亡率和中度/严重的患者假肢不匹配率在各组之间相似.
结论:
- 大动脉环形扩大可能对患有小本土大动脉环形的患者有益,这些患者经历了孤立的AVR.
- 在这个患者队列中,AAE是中期死亡率的独立保护因素.
- 进一步的研究可能会探索对AAE的最佳患者选择.
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