门节约性根部更换:多大年龄是太老了吗?
Elizabeth L Norton1, Yanhua Wang2, Parth M Patel1
1Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Ga.
JTCVS open
|July 9, 2025
概括
节能根置换 (VSRR) 显示出良好的结果,但老年患者 (65岁以上) 面临更高的死亡率. 65岁以上的年龄是晚期死亡的风险因素,尽管重新手术率仍然相似. 建议对老年患者进行仔细考虑.
科学领域:
- 心血管外科心血管外科
- 大动脉根部外科手术
- 老年心脏病学 老年心脏病学
背景情况:
- 节约根部更换 (VSRR) 提供了优秀的短期和长期效果.
- 虽然通常在年轻的患者中进行,但VSRR在广泛的年龄范围内使用,包括70多岁的个人.
- 年龄和并发症对VSRR结果的影响需要进一步调查.
研究的目的:
- 分析年龄和手术前并发症对VSRR后手术结果的影响.
- 评估年龄对复手率和VSRR后的存活率的影响.
- 根据长期存活数据,确定VSRR的最佳年龄截止值.
主要方法:
- 在2004年至2021年期间接受VSRR治疗的780名患者的回顾性分析.
- 使用大卫V再植入技术进行了VSRR.
- 根据65岁的年龄截止值,患者被分为两组,使用Contal和O'Quigley方法确定.
主要成果:
- 65岁的年龄截止被认为是最佳的;16%的患者≥65岁.
- 在65岁以上的患者中,住院死亡率更高 (4.1%对1.1%,P=.03).
- 65岁以上的患者的十年生存率显著下降 (76%与92%相比,P<.0001),65岁以上的年龄是晚期死亡的独立风险因素.
结论:
- 在各个年龄组中,VSRR可以执行,手术死亡率低,并且无需重新手术.
- 65岁及以上接受VSRR治疗的患者需要仔细考虑,特别是在主动脉剖析的情况下.
- 年龄≥65岁是VSRR后晚期死亡的一个独立风险因素.
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