在老年患者中进行大动脉根置换的最佳策略:门节约根置换或生物Bentall?
Elizabeth L Norton1, Parth M Patel1, Dov Levine2
1Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
The Journal of thoracic and cardiovascular surgery
|March 9, 2026
概括
节能根置换 (VSRR) 和Bio-Bentall手术在65岁及以上的患者中提供了很好的结果. VSRR显示出更好的长期存活率,使其成为选择老年患者的合适选择.
科学领域:
- 心血管外科心血管外科
- 大动脉根的替代术
- 老年人心脏病护理服务
背景情况:
- 节节根置换 (VSRR) 越来越多地在老年患者 (≥65岁) 中进行.
- 在这个人口群体中,VSRR与Bio-Bentall程序的比较结果尚未确立.
研究的目的:
- 评估和比较VSRR和Bio-Bentall手术在65岁及以上患者的临床结果.
- 评估短期和长期的生存率,并发症和资源利用率,用于两个手术方法.
主要方法:
- 在2004年至2021年期间接受了选择性大动脉根置换的330名患者 (≥65岁) 的回顾性分析.
- 患者接受了VSRR (n=94) 或Bio-Bentall (n=236) 程序.
- 排除标准包括非选择性病例,中度至重度的大动脉狭窄,先前的大动脉置换和机械本塔尔手术.
主要成果:
- 与Bio-Bentall相比,VSRR患者的通风时间较短,住院时间较短.
- 住院死亡率在两组之间是相似的 (2.1%的VSRR与3.0%的Bio-Bentall相比,p=0.73).
- VSRR显示出更高的12年生存率 (70%与59%,p=0.03) 与相似的重新操作率.
结论:
- 在65岁及以上的患者中,VSRR和Bio-Bentall都对大动脉根置换是安全有效的.
- VSRR与更好的长期存活率和改善的短期恢复指标有关.
- 在没有显著的膜退行或并发症的老年患者中,VSRR是选择性大动脉根置换的可行选择.
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