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作为高风险群体的管理策略,过境时间流管理是进行冠状动脉旁路移植的高风险群体

John Kucera¹, John Duggan¹, Alex Peters¹

¹Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA.

Journal of cardiothoracic surgery

|March 22, 2025

概括

过渡时间流量测量 (TTFM) 对糖尿病 (DM) 和末期病 (ESRD) 患者的冠状动脉旁路移植 (CABG) 的手术决定产生重大影响,特别是在非手术过程中. 这种工具有助于优化运营战略并改善结果.

科学领域:

心血管外科心血管外科
医疗成像医学成像
腎臟病學 (nephrology) 是一種醫學專業.

背景情况:

冠状动脉旁路移植 (CABG) 结果对于糖尿病患者 (DM) 和末期脏疾病 (ESRD) 患者至关重要.
用超声波和过渡时间流量测量 (TTFM) 等术内工具评估外科决策对于高风险人群至关重要.
在这些患者群体中,将内 (ONCAB) 与外 (OPCAB) CABG 策略进行比较需要仔细分析.

研究的目的:

评估TTFM和高频超声波 (HFUS) 对接受CABG的DM和ESRD患者手术结果的影响.
确定TTFM和HFUS在指导ONCAB和OPCAB程序的业内决策中的实用性.
确定这些技术如何影响复杂患者队列中的手术策略变化.

主要方法:

分析了来自多中心REQUEST注册表 (超声波成像和心脏绕道手术中TTFM测量质量评估注册表) 的数据.
对患有DM,ESRD和接受ONCAB和OPCAB的患者来说,结果被分层化.
主要结局是计划中的外科手术程序的任何变化,其次要终点包括移植修改和住院发病/死亡率.

主要成果:

在糖尿病患者 (10.2%对6.4%) 和ESRD患者 (33.7%对24.3%) 中,TTFM的使用与大动脉组成部分的手术策略变化的更高率有关.
在OPCAB手术中,TTFM和HFUS的使用导致了与ONCAB相比,对大动脉部分的更大战略变化 (14.7%对3.4%).
在1016个分析的CABG手术中,住院死亡率很低,为0.6%.

结论:

在ESRD和DM患者中,TTFM显著影响了手术内决策和手术策略变化,特别是在OPCAB与ONCAB相比.
观察到的差异可能与OPCAB中较高的平均移植流量有关,用于移植质量评估的标准化TTFM截止值.
通过对结果和手术内决策产生积极影响,特别是在高风险患者群体中,TTFM在CABG中发挥了宝贵的作用.

关键词:

冠状动脉绕道移植冠状动脉绕道移植糖尿病糖尿病糖尿病欧洲发展与发展委员会 (ESRD)关闭抽冠状动脉绕道移植在冠状动脉旁路移植上过境时间流管理

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