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在A型大动脉剖析患者中,门节约与大动脉根置换的倾向性得分匹配分析

Ling Chen^1,2,3, Yichao Pan⁴, Huaijian Zhang⁵

¹Department of Cardiac Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, 350001, People's Republic of China.

Nature communications

|January 31, 2025

概括

门节约根置换 (VSRR) 在急性大动脉解剖中显示出比大动脉根置换 (ARR) 更好的长期存活率. 重复干预率相似,这表明VSRR受益于被选中的患者.

科学领域:

心血管外科心血管外科
胸部外科手术胸部外科手术
大动脉疾病管理管理

背景情况:

甲型急性大动脉解剖 (AAD) 需要复杂的大动脉根修复.
有限的前性数据存在,比较门节约根置换 (VSRR) 和大动脉根置换 (ARR).
了解长期结果对于AAD的外科决策至关重要.

研究的目的:

在AAD患者中比较VSRR和ARR之间的长期存活率和再干预率.
确定影响VSRR和ARR之间选择的因素.
评估VSRR在特定患者亚组中的疗效.

主要方法:

对743名接受AAD的VSRR (n=244) 或ARR (n=499) 的患者进行了回顾性分析.
多变量分析以确定ARR的预测因素.
倾向性得分匹配 (PSM) 和治疗权重反向概率 (IPTW) 用于结果比较.

主要成果:

与PSM后的ARR (64.1%) 相比,VSRR显示出明显更高的5年生存率 (80.2%),而PSM后的ARR (64.1%) (P=0.001).
在VSRR和ARR之间,再干预率是可比的.
内心炎在ARR中更频繁,而大动脉吐在VSRR中更常见.

结论:

与ARR相比,VSRR在适当选择的AAD患者中提供了优越的长期存活率.
对年轻患者 (<60岁) 和BMI>24的患者来说,VSRR可能是有利的.
这些发现支持在适合AAD修复的候选物中增加VSRR的利用率.

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