一个多机构研究患者假体不匹配的患病率和临床影响在手术大动脉置换中的多机构研究
Lucy Nam1, Ruby Singh1, Sameer A Hirji2
1Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts.
The Annals of thoracic surgery
|May 17, 2025
概括
大动脉置换后的假肢患者不匹配率 (PPM) 正在下降,但仍与更糟糕的结果有关. 老年女性面临更高的PPM风险,需要量身定制的手术方法.
科学领域:
- 心脏病学 心脏病学
- 心脏外科手术 心脏外科手术
- 生物医学工程 生物医学工程
背景情况:
- 假肢-患者不匹配 (PPM) 负面影响了手术大动脉置换 (SAVR) 的结果.
- 目前对PPM的临床影响,趋势和预测因素的理解有限.
研究的目的:
- 调查PPM患病率的当前趋势及其与SAVR后临床结果的关联.
- 确定PPM的预测因素,重点关注年龄和性别差异.
主要方法:
- 在10607名接受SAVR (2002-2023) 的患者中进行的多机构研究.
- 按身体表面积 (EOAi) 的有效孔径面积评估的PPM,对肥胖的修改标准 (BMI ≥30 kg/m2) 进行评估.
- 使用卡普兰-梅尔和多变量分析分析的结果,按年龄和性别分层.
主要成果:
- 在过去十年中,PPM的患病率从31%降至18%,与更大的假肢和增加的环状扩大有关.
- PPM与更高的30天死亡率 (OR 1.46) 和降低的长期存活率有关.
- 高龄对女性比男性的PPM风险更大 (OR 2.31对1.66).
结论:
- 尽管由于技术进步导致患病率下降,但PPM仍然是不利SAVR结果的重要预测因素.
- 老年女性患者表现出明显的风险,需要有针对性的策略,如仔细选择假肢和考虑环状扩大.
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