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在不同年龄组隔离性外科动脉置换后,减少长期存活的危险因素

Rosalind Groenewoud¹, Defen Peng², Byron H Gottschalk¹

¹Division of Cardiac Surgery, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.

The Canadian journal of cardiology

|November 4, 2024

概括

这项研究确定了跨年龄组进行大动脉置换手术 (SAVR) 后生存率降低的风险因素. 肺高血压是一个普遍的风险因素,指导SAVR和透管大动脉置换 (TAVR) 之间的决定.

科学领域:

心血管外科心血管外科
干预心脏病学干预心脏病学
生物材料科学生物材料科学

背景情况:

目前的指导方针推基于年龄和预期寿命的低风险患者进行透气管和外科动脉置换 (TAVR和SAVR).
了解SAVR后降低生存率和重复干预率的风险因素对于最佳的患者选择至关重要.

研究的目的:

为了确定独立的风险因素,以减少预期寿命后孤立SAVR.
为了确定不同年龄组的重复大动脉 (AV) 干预的速度.
以患者特征为基础,为最佳干预策略提供信息.

主要方法:

分析了2000年至2015年间接受Carpentier-Edwards心脏周围组织门隔离SAVR的2026名患者队列.
多变量模型被用来确定三个不同的年龄组内的长期存活的独立风险因素.

主要成果:

十年生存率因年龄组而异:83.4% (<65岁),72.7% (65-74岁) 和39.8% (≥75岁).
减少生存的独立风险因素包括肺高血压 (PH),功能衰竭,周围血管疾病,糖尿病和NYHA类IV (年龄<65岁);PH,糖尿病,吸烟和心房失常 (65-74岁);PH,贫血和NYHA类IV (年龄≥75岁).
在年轻患者 (<65岁) 中,10年复发AV干预率与老年人群相比 (14.7%与3.4%和0.8%) 显著更高.

结论:

肺高血压成为所有年龄组中减少长期存活的唯一一致的危险因素.
这些发现有助于对SAVR与TAVR的决策,特别是在具有更高重复干预率的年轻患者中.
在65岁以上的患者中,重复干预的低率支持目前对这一人口群体生物假体的建议.

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