在年轻人中孤立的风湿性大动脉门疾病手术后的结果:手术前的左心室功能障碍是增加死亡率的危险因素
Hilary A Hardefeldt1, Steven Kiyokawa2, Thomas L Gentles2,3
1Queensland Paediatric Cardiac Service, Queensland Children's Hospital, Brisbane, Queensland, Australia.
概括
患有风湿性大动脉病的小儿患者接受手术时,如果他们有手术前的左心室 (LV) 功能障碍,死亡风险更高. 这种风险因人体表面积而增大,导致频繁的重复手术和长期并发症.
科学领域:
- 心脏病学 心脏病学
- 儿科心脏手术 儿科心脏手术
- 膜心脏疾病 膜心脏疾病
背景情况:
- 风湿性大动脉膜疾病显著影响年轻患者.
- 了解这一群体的手术指示和结果至关重要.
研究的目的:
- 分析18岁以下患者的风湿性大动脉膜疾病心脏手术的结果.
- 在这个群体中确定死亡率和并发症的风险因素.
主要方法:
- 对39名患者 (<18岁) 的回顾性队列研究,这些患者因单独的风湿性大动脉病 (2000-2019) 接受手术.
- 收集了基线,中期和晚期随访的数据,包括左心室 (LV) 功能.
- LV 功能障碍定义为 LV 喷射分数 <55% 或 LV 缩短分数 <27%.
主要成果:
- 总体死亡率为20% (8/39),其中43% (17/39) 需要重新手术.
- 手术前的 LV 功能障碍显著增加了死亡风险 (HR 13.3,P=.003),这一效应被身体表面积 (BSA) 放大.
- 观察到高持续性LV功能障碍率 (53%在后期随访) 和门相关并发症.
结论:
- 手术前的LV功能障碍是患有风湿性大动脉门手术的儿科患者死亡率的关键预测因素.
- 更高的BSA加剧了与LV功能障碍相关的死亡风险.
- 该研究强调了重复手术和晚期并发症的高发病率,需要长期监测.
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