二叶式主动脉瓣主动脉胸段管理方法的转变。
A shifting approach to management of the thoracic aorta in bicuspid aortic valve.
机构信息
Department of Cardiology, Boston Children's Hospital, Boston, Mass 02115, USA.
出版信息
J Thorac Cardiovasc Surg. 2013 Aug;146(2):339-46. doi: 10.1016/j.jtcvs.2012.10.028. Epub 2012 Nov 9.
OBJECTIVES
The scientific understanding of aortic dilation associated with bicuspid aortic valve (BAV) has evolved during the past 2 decades, along with improvements in diagnostic technology and surgical management. We aimed to evaluate secular trends and predictors of thoracic aortic surgery among patients with BAV in the United States.
METHODS
We used the 1998-2009 Nationwide Inpatient Sample, an administrative dataset representative of US hospital admissions, to identify hospitalizations for adults aged 18 years or more with BAV and aortic valve or thoracic aortic surgery. Covariates included age, gender, year, aortic dissection, endocarditis, thoracic aortic aneurysm, number of comorbidities, hospital teaching status and region, primary insurance, and concomitant coronary artery bypass surgery.
RESULTS
Between 1998 and 2009, 48,736 ± 3555 patients with BAV underwent aortic valve repair or replacement and 1679 ± 120 patients with BAV underwent isolated thoracic aortic surgery. The overall number of surgeries increased more than 3-fold, from 4556 ± 571 in 1998/1999 to 14,960 ± 2107 in 2008/2009 (P < .0001). The proportion of aortic valve repair or replacement including concomitant thoracic aortic surgery increased from 12.8% ± 1.4% in 1998/1999 to 28.5% ± 1.6% in 2008/2009, which mirrored an increasing proportion of patients with a diagnosis of thoracic aortic aneurysm. Mortality was equivalent for patients undergoing aortic valve repair or replacement with thoracic aortic surgery and those undergoing isolated aortic valve repair or replacement (1.8% ± 0.3% vs 1.5% ± 0.2%; multivariable odds ratio, 1.02; 95% confidence interval, 0.67-1.57), with decreasing mortality over the study period (from 2.5% ± 0.6% in 1998/1999 to 1.5% ± 0.2% in 2008/2009; multivariable odds ratio per 2-year increment, 0.89; 95% confidence interval, 0.81-0.99; P = .03). Total charges for BAV surgical hospitalizations increased more than 7.5-fold from approximately $156 million in 1998 to $1.2 billion in 2009 (inflation-adjusted 2009 dollars).
CONCLUSIONS
There was a marked increase in the use of thoracic aortic surgery among patients with BAV.
目的
在过去的 20 年中，随着诊断技术和手术管理的改进，人们对与二叶式主动脉瓣（BAV）相关的升主动脉扩张的科学认识不断发展。我们旨在评估美国 BAV 患者行胸主动脉手术的趋势和预测因素。
方法
我们使用了 1998 年至 2009 年的全国住院患者样本，这是一个代表美国住院患者的行政数据集，以确定 18 岁或以上患有 BAV 和主动脉瓣或胸主动脉手术的住院患者。协变量包括年龄、性别、年份、主动脉夹层、心内膜炎、胸主动脉瘤、合并症数量、医院教学地位和地区、主要保险以及同时进行的冠状动脉旁路手术。
结果
1998 年至 2009 年间，48736 名±3555 名 BAV 患者接受了主动脉瓣修复或置换术，1679 名±120 名 BAV 患者接受了单纯胸主动脉手术。手术总数增加了三倍多，从 1998/1999 年的 4556±571 例增加到 2008/2009 年的 14960±2107 例（P<.0001）。包括胸主动脉手术在内的主动脉瓣修复或置换术的比例从 1998/1999 年的 12.8%±1.4%增加到 2008/2009 年的 28.5%±1.6%，这与胸主动脉瘤诊断患者比例的增加相吻合。接受主动脉瓣修复或置换联合胸主动脉手术的患者与接受单纯主动脉瓣修复或置换的患者的死亡率相当（1.8%±0.3%与 1.5%±0.2%；多变量优势比，1.02；95%置信区间，0.67-1.57），研究期间死亡率呈下降趋势（从 1998/1999 年的 2.5%±0.6%降至 2008/2009 年的 1.5%±0.2%；每两年增加的多变量优势比，0.89；95%置信区间，0.81-0.99；P=.03）。BAV 手术住院治疗的总费用从 1998 年的约 1.56 亿美元增加到 2009 年的 120 亿美元（经通胀调整的 2009 年美元），增加了 7.5 倍以上。
结论
BAV 患者行胸主动脉手术的应用明显增加。
Zotero 插件