初始手术与慢性严重大动脉吐在轻度症状老年患者的保守管理
Mijin Kim1,2, Ha Hye Jo2,3, Sahmin Lee2
1Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.
概括
大动脉置换 (AVR) 显著降低了老年患者的死亡率,这些老年患者患有严重的大动脉吐 (AR) 和轻微症状. 年龄本身不应该阻止AVR,因为它改善了生存结果.
科学领域:
- 心脏病学 心脏病学
- 心脏外科手术 心脏外科手术
- 老年医学 老年医学
背景情况:
- 严重的大动脉反 (AR) 具有显著的风险,特别是在老年患者中.
- 进行大动脉置换 (AVR) 的决定需要仔细考虑操作风险与益处.
- 患有严重AR轻度症状的老年人对手术干预具有独特的挑战.
研究的目的:
- 评估AVR对老年患者的生存优势,这些老年患者由于严重的AR而出现轻度症状.
- 为了比较手术治疗和保守管理的严重AR老年患者之间的死亡率.
- 为了确定AVR是否在外科手术风险令人担忧的人群中提供生存益处.
主要方法:
- 一项回顾性研究评估了127名老年患者,在1996年至2016年期间,他们患有严重的AR和轻度症状.
- 患者被分为两组:接受AVR的患者 (n=35) 和保守管理的患者 (n=92).
- 在AVR和保守管理组之间,所有原因和心脏死亡率在4.2年的中位数随访期间进行了比较.
主要成果:
- 与保守的组相比,AVR组显示出明显较低的全因死亡率 (22.9%vs62.0%) 和心脏死亡率 (8.6%vs33.7%).
- 多变量分析证实,AVR与减少全因死亡率 (HR 0.41) 和心脏死亡率 (HR 0.29) 独立相关.
- 尽管AVR组年轻,但手术风险得分和心脏尺寸等基线特征相似,这表明AVR的好处不仅仅是由于患者的选择.
结论:
- 在老年患者中,AVR提供了显著的生存益处,减少了所有原因和心脏病死亡率,这些患者有严重的AR和轻微的症状.
- 在这个患者队列中,年龄不应该是AVR的禁忌.
- 这些发现支持在轻度症状的老年人中考虑AVR,以改善长期存活率.
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