双动脉和三动脉中的门节约根置换:长期结果进入第二个十年
Katrien François1, Isabelle Claus1, Joke Verlinden1
1Cardiac Surgery, University Hospital Ghent, Belgium.
The Annals of thoracic surgery
|May 30, 2025
概括
节性大动脉根置换 (VSRR) 对三大动脉 (TAV) 显示出优异的长期结果. 双主动脉 (BAVs) 需要更多的重复手术,特别是在手术后低于最佳的门功能.
科学领域:
- 心血管外科心血管外科
- 大动脉膜疾病 大动脉膜疾病
- 大动脉根动脉瘤
背景情况:
- 门节约性大动脉根置换 (VSRR) 是一种用于大动脉根动脉瘤的技术.
- 最初开发用于三主动脉 (TAVs),VSRR已经扩展到双主动脉 (BAVs).
- 在TAV和BAV中,VSRR的长期结果需要分析.
研究的目的:
- 为了比较TAVs与BAVs患者的VSRR的长期结果.
- 在VSRR之后确定大动脉重新干预的预测因素.
- 评估死亡率和从显著的大动脉反 (AR) 的自由.
主要方法:
- 从2000年到2023年连续接受VSRR的患者的回顾性分析.
- 与BAV和TAV患者之间的结局的比较.
- 主要终点:大动脉重新干预;次要终点:死亡率和无AR ≥2/4.4.
主要成果:
- 包括239名患者 (66名BAV,173名TAV) 在人口统计和适应症方面存在显著差异.
- 在BAV (84.8%) 中,骨修复的发生率高于TAV (24.9%).
- 在平均7.9年的随访后,16.7%的BAV和5.2%的TAV需要重新手术 (P = .004).
- 在BAV中,峰值梯度较高,AR≥2/4.4
- 多变量分析确定了BAV (HR, 3.717) 和放电时的AR程度 (HR, 2.745) 作为重新操作的预测指标.
结论:
- 在TAV中的VSRR显示出稳定的长期结果与低的重新运行率 (约. 在15岁时为5%).
- BAVs 呈现出更大的疾病进展,大约有17%需要早期重新手术.
- 排放时门的低于最佳功能是影响BAV重新启动率的关键因素.
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