修复与替换:一个多中心的研究
Giulio Massimi1,2, Matteo Matteucci1,3, Michele De Bonis4
1Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands.
概括
在心肌梗塞后的乳头肌肉破裂手术显示,美心修复和更换之间死亡率没有显著差异. 然而,同时进行冠状动脉旁路移植改善了住院生存率.
科学领域:
- 心血管外科
- 干预心脏病学
- 心脏手术的结果
背景情况:
- 乳头肌肉破裂 (PMR) 是急性心肌梗塞 (AMI) 后的一种罕见,危及生命的并发症.
- 外科手术是标准的治疗方法,
- 本研究分析了CAUTION研究数据库的结果.
研究的目的:
- 为了比较中膜修复 (MVr) 与中膜更换 (MVR) 在AMI后的PMR的有效性.
- 确定影响住院和长期死亡的因素.
- 评估并发性冠状动脉旁路移植 (CABG) 的影响.
主要方法:
- 来自20个国际中心的218名接受MVR或MVR治疗的AMI后PMR患者 (2001-2019) 的回顾性分析.
- 住院和长期出院后死亡率的比较.
- 多变量逻辑回归以确定死亡率的独立预测因素.
主要成果:
- 在81. 6%的病例中进行了MVR,通常是完全的PMR,而在部分的PMR中则更频繁.
- 住院死亡率为MVR的25.8%和MVR的20% (p=0. 440).
- 长期存活率在MVR和MVR组之间没有显著差异 (p=0. 474).
- 同时使用CABG与MVR组的住院死亡率较低有关 (21%与31. 7%相比,p=0. 035).
- 使用CABG的MVr显著提高了长期存活率 (p< 0. 001).
结论:
- 在完整的PMR中使用MVR,在部分的PMR中使用MVR.
- 在MVR和MVR之间没有观察到入院或长期死亡率的显著差异.
- 同时使用CABG与改善住院生存率有关,特别是在MVR组.
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