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贝顿手术:它是金标准吗?一组连续 597 例病例。

The Bentall procedure: is it the gold standard? A series of 597 consecutive cases.

机构信息

Departments of Cardiothoracic Surgery and Anesthesia, Mount Sinai School of Medicine, New York, NY, USA.

出版信息

J Thorac Cardiovasc Surg. 2010 Dec;140(6 Suppl):S64-70; discussion S86-91. doi: 10.1016/j.jtcvs.2010.07.033.

Abstract

OBJECTIVES

We compared aortic root reconstructions using conduits with biological valves and mechanical valves.

METHODS

Of 597 patients (1995-2008), 307 (mean age 71 years [23-89 years]) had biological valves and 290 (mean age 51 years [21-82 years]) had mechanical valves. The subgroup of 242 patients aged 50 to 70 years included 133 with biological and 109 with mechanical valves.

RESULTS

Overall hospital mortality was 3.9% with biological valves (n = 15; elective: 3.7% [n = 10]) versus 2.8% with mechanical valves (n = 8; elective: 1.4% [n = 3]). In patients 50 to 70 years, age greater than 65 years (relative risk: 3.3 [P = .0001]), clot (relative risk: 2.5 [P = .05]), coronary artery disease (relative risk:3.5 [P < .0001]), and degenerative etiology (relative risk: 0.4 [P = .006]) were independent risk factors for long-term survival (after postoperative day 30); there was no difference in long-term survival between biological and mechanical valves (relative risk: 0.9 [P = .74]). The linearized rate for valve/ascending aorta reoperation was 0.86%/pt-y (2 in 2310 pt-y) after mechanical valves and 2.5%/pt-y (4 in 1586 pt-y) after Bentall procedures with the biological valve.

CONCLUSIONS

The choice of valve for aortic root reconstruction seems to have no influence on long-term outcome. Emergency operation and the presence of clot/atheroma have a significant impact on short-term outcome. Reoperation for either ascending aorta and/or aortic valve is low.

摘要

目的

比较使用带生物瓣和机械瓣的管道进行主动脉根部重建。

方法

597 例患者(1995-2008 年)中,307 例(平均年龄 71 岁[23-89 岁])使用生物瓣,290 例(平均年龄 51 岁[21-82 岁])使用机械瓣。242 例年龄在 50 至 70 岁的亚组中,133 例使用生物瓣,109 例使用机械瓣。

结果

整体院内死亡率为生物瓣组 3.9%(n = 15;择期手术:3.7%[n = 10]),机械瓣组 2.8%(n = 8;择期手术:1.4%[n = 3])。在 50 至 70 岁的患者中,年龄大于 65 岁(相对风险:3.3[P =.0001])、血栓形成(相对风险:2.5[P =.05])、冠状动脉疾病(相对风险:3.5[P<.0001])和退行性病因(相对风险:0.4[P =.006])是术后 30 天长期生存的独立危险因素;生物瓣和机械瓣之间的长期生存率无差异(相对风险:0.9[P =.74])。机械瓣的线性化瓣膜/升主动脉再手术率为 0.86%/pt-y(2/2310 pt-y),而 Bentall 手术后生物瓣的线性化率为 2.5%/pt-y(4/1586 pt-y)。

结论

主动脉根部重建中瓣膜的选择似乎对长期结果没有影响。急诊手术和血栓/动脉粥样硬化的存在对短期结果有显著影响。无论是升主动脉还是主动脉瓣的再手术率都较低。

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