临床特征和老年患者的术后结果,这些老年患者因心肌缩性心脏病变而接受隔膜切除术
Tedy Sawma1, Hartzell V Schaff1, Fernando Juarez-Casso1
1Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
The Journal of thoracic and cardiovascular surgery
|October 10, 2024
概括
截面肌切除术对于患有阻塞性多变性心肌病的老年人来说是一种安全的手术,显示出改善了生活质量. 然而,左心室壁不对称表明这个年龄组的预后较差.
科学领域:
- 心脏病学 心脏病学
- 心脏外科手术 心脏外科手术
- 老年医学 老年医学
背景情况:
- 阻塞性缩性心肌病变 (HCM) 在老年人中由于外科手术风险而经常未得到充分治疗.
- 隔膜缩小疗法旨在缓解症状并改善HCM患者的治疗结果.
- 了解HCM呈现和手术结果的年龄相关差异对于临床决策至关重要.
研究的目的:
- 为了比较患有阻塞性HCM的隔膜肌切除术的年轻和老年患者之间的临床和心声学特征.
- 评估不同年龄组接受隔膜肌切除术的早期和晚期术后结果.
- 评估隔膜肌切除术在患有阻塞性HCM的老年患者中的安全性和有效性.
主要方法:
- 在2000年至2021年间,对2663名接受过门隔膜肌切除术的患者进行了回顾性分析.
- 患者被分为三个年龄组:18-64岁,65-74岁和75岁或以上.
- 临床数据,心声回声检测结果和术后结果被分析并通过不同年龄组进行比较.
主要成果:
- 老年患者表现出明显的特征,包括更高的女性性别,高血压和糖尿病的患病率,但具有相似的功能限制.
- 老年患者的壁面较薄,隔膜不对称性较少,病人的住院死亡率较高 (1.3%在≥75岁) 和5年生存率较低 (91%在≥75岁).
- Septal-to-posterior墙壁厚度比率与老年人 (≥65岁) 的死亡率增加相关,而大多数患者报告说,手术后生活质量有所改善.
结论:
- 阻塞性缩性心肌病在老年人中呈现不同,具有不同的临床和形态变异.
- 截面肌切除术对于患有阻塞性HCM的老年患者来说是一种安全有效的治疗选择,可以改善生活质量.
- 左心室壁不对称是接受隔膜肌切除术的老年患者预后较差的重要预测因素.
更多相关视频
09:12Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
Published on: March 27, 2018
9.4K
08:42Cox-Maze IV Procedure Concomitant with Valvular Surgery In Situs Inversus Dextrocardia: A Single-Center Experience in China
Published on: February 11, 2022
3.4K
相关概念视频
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
3
Patients with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract (LVOT) obstruction who remain symptomatic despite optimal medical therapy may undergo a septal myectomy (Morrow procedure). This procedure involves excising a portion of the hypertrophied septum below the aortic valve using a heart-lung machine to improve blood flow through the LVOT. Effective preoperative and postoperative nursing management ensures successful patient outcomes, minimizes complications, and...
3
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy
1
Hypertrophic cardiomyopathy, or HCM, is an autosomal dominant genetic disorder characterized by asymmetric left ventricular hypertrophy without ventricular dilation. It is more common in men and is typically diagnosed in young, athletic adults.EtiologyHCM is primarily genetic and is caused by mutations in genes encoding sarcomeric proteins. Researchers have identified over 1400 mutations across at least 11 different genes. Among these, the most frequently occurring mutations are found in the...
1
01:29Cardiomyopathy V: Interprofessional Care
2
Managing cardiomyopathy involves addressing underlying or precipitating causes, treating heart failure with medications, and implementing dietary changes and a balanced exercise and rest regimen.Lifestyle ModificationsCardiomyopathy patients should adopt a low-sodium diet to reduce fluid retention and manage heart failure. A personalized exercise and rest plan helps maintain physical fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent further damage to...
2
01:30Cardiomyopathy II: Dilated Cardiomyopathy
1
Dilated cardiomyopathy, or DCM, is a progressive myocardial disorder characterized by ventricular chamber dilation and contractile dysfunction.EtiologyVarious factors can cause DCM, including hypertension and heavy alcohol intake, which contribute to the weakening and enlargement of the heart muscle. Viral infections, such as Coxsackievirus B, adenoviruses, and influenza, can lead to DCM by causing inflammation and damage to heart tissue. Certain chemotherapeutic agents, including daunorubicin,...
1
01:23Mitral Stenosis II: Clinical features and Diagnostic Tests
3
Mitral stenosis is a heart condition in which the mitral valve, which allows blood to flow from the left atrium to the left ventricle, becomes narrowed or stenotic. This narrowing hinders blood flow and leads to clinical symptoms requiring specific medical evaluations and management strategies. The following overview outlines the clinical symptoms, assessments, diagnostic findings, prevention methods, and treatments for mitral stenosis.Clinical ManifestationsDyspnea (shortness of breath): This...
3
01:29Cardiomyopathy VI: Nursing Management
2
Assessment: Nursing management of patients with cardiomyopathy begins with a thorough assessment of the patient's history, including a family history of cardiomyopathy or sudden cardiac death, personal history of heart disease, hypertension, diabetes, and any alcohol consumption or drug use.During the physical examination, assess vital signs, look for signs of heart failure (such as edema, jugular venous distention, and cyanosis), auscultate for abnormal heart sounds (like murmurs and gallops),...
2