门节约性大动脉根替换带有副门窗的门:哪个门会失效?
Fabian A Kari1,2,3, Martin Czerny4,5, Michael Borger6
1Department of Cardiac Surgery, LMU University Hospital, Munich, Germany.
概括
门节约性大动脉根置换 (VSARR) 的结果在多重窗体或不均的尖端边缘的情况下更糟. 识别这些风险因素可以改善患者对VSARR手术的选择.
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
- 心脏外科手术 心脏外科手术
背景情况:
- 在接受节动脉根置换 (VSARR) 的大动脉膜中,准管化很常见.
- 影响这些患者VSARR结果的形态风险因素需要定义.
研究的目的:
- 为了确定特定的形态风险星座与不良后果相关的患者接受VSARR对甲状腺膜与paracommissural fenestrations.
- 改善VSARR患者的患者选择和手术规划.
主要方法:
- 分析了来自德国大动脉根修复登记处 (GEARR) 的前性数据.
- 选了接受VSARR治疗的带有paracommissural cusp fenestration的患者.
- 结合的终点包括CPB后的残留大动脉吐 (rAR),中期的rAR进展和AR的大动脉置换.
主要成果:
- 在762名患者中,有145名患者进行了副学术尖端;18%的患者需要替代手术.
- 在3年的随访中,观察到78%的结合终点自由.
- 与≥5mm (41%) 相比,自由边缘长度差异<5mm的患者有明显更好的结果 (86%).
- 部脱落结合自由边缘长度差异>5毫米显示出最糟糕的结果 (30%的自由从终点).
结论:
- 多个尖端的窗口,不均的无尖端边缘长度和额外的尖端落与VSARR后的劣质结果有关.
- 这些形态因素对于接受VSARR治疗的患者的风险分层至关重要.
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