使用无缝合瓣膜可获得更好的短期预后：倾向匹配评分分析。
Better short-term outcome by using sutureless valves: a propensity-matched score analysis.
作者信息
Pollari Francesco, Santarpino Giuseppe, Dell'Aquila Angelo Maria, Gazdag Laszlo, Alnahas Husam, Vogt Ferdinand, Pfeiffer Steffen, Fischlein Theodor
机构信息
Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medizinischen Privatuniversität, Nuremberg, Germany.
Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medizinischen Privatuniversität, Nuremberg, Germany.
出版信息
Ann Thorac Surg. 2014 Aug;98(2):611-6; discussion 616-7. doi: 10.1016/j.athoracsur.2014.04.072. Epub 2014 Jun 10.
BACKGROUND
Sutureless aortic valve prostheses have the potential of shortening ischemic time. However, whether shorter operative times may also result in improved patient outcomes and have an effect on hospital costs remains to be established.
METHODS
From March 2010 to April 2013, 566 patients underwent aortic valve replacement with bioprostheses; of these, 166 received a sutureless valve, and 400 received a stented valve. Redo and associated procedures were included. A propensity-score analysis was used to create two groups (sutureless and stented) with 82 matched pairs with comparable preoperative characteristics. Hospital outcome, follow-up, and health care resource consumption were compared.
RESULTS
There were 3 hospital deaths in the stented group and 2 in the sutureless group (p=0.65). Aortic cross-clamp, cardiopulmonary bypass, and operation times were significantly shorter in the sutureless group (p<0.001). Patients in the sutureless group required blood transfusion less frequently (1.2±1.3 vs 2.5±3.7 units, p=0.005), with a similar need for reexploration for bleeding (2 vs 5, p=0.221). The sutureless group had a shorter intensive care unit stay (2.0±1.2 vs 2.8±1.3 days, p<0.001), hospital stay (10.9±2.7 vs 12.4±4.4 days, p=0.001) and intubation time (9.5±4.6 vs 16.6±6.4 hours, p<0.001), and a lower incidence of postoperative atrial fibrillation (p=0.015), pleura effusions (p=0.024), and respiratory insufficiency (p=0.016). Pacemaker implantation and occurrence of neurologic events were similar between groups (p>0.05). A lower rate of postoperative complications resulted in reduced resource consumption in the sutureless group for diagnostics (€2,153 vs €1,387), operating room (€5,879 vs €5,527), and hospital stay (€9,873 vs €6,584), with a total cost saving of approximately 25% (€17,905 vs €13,498).
CONCLUSIONS
A shorter procedural time in the sutureless group is associated with better clinical outcomes and reduced hospital costs.
背景
无缝合主动脉瓣膜假体有缩短缺血时间的潜力。然而，手术时间缩短是否也能改善患者预后并影响医院成本仍有待确定。
方法
2010年3月至2013年4月，566例患者接受了生物假体主动脉瓣置换术；其中，166例接受了无缝合瓣膜，400例接受了带支架瓣膜。再次手术及相关手术均包括在内。采用倾向评分分析创建两组（无缝合组和带支架组），每组82对匹配，术前特征相当。比较两组的医院结局、随访情况及医疗资源消耗。
结果
带支架组有3例医院死亡，无缝合组有2例（p = 0.65）。无缝合组的主动脉阻断、体外循环及手术时间显著缩短（p < 0.001）。无缝合组患者输血频率较低（1.2±1.3单位 vs 2.5±3.7单位，p = 0.005），再次手术止血需求相似（2例 vs 5例，p = 0.221）。无缝合组的重症监护病房住院时间较短（2.0±1.2天 vs 2.8±1.3天，p < 0.001），住院时间较短（10.9±2.7天 vs 12.4±4.4天，p = 0.001），插管时间较短（9.5±4.6小时 vs 16.6±6.4小时，p < 0.001），术后房颤（p = 0.015）、胸腔积液（p = 0.024）及呼吸功能不全（p = 0.016）的发生率较低。两组间起搏器植入及神经系统事件发生率相似（p > 0.05）。术后并发症发生率较低使得无缝合组在诊断（2153欧元 vs 1387欧元）、手术室（5879欧元 vs 5527欧元）及住院（9873欧元 vs 6584欧元）方面的资源消耗减少，总成本节省约25%（17905欧元 vs 13498欧元）。
结论
无缝合组较短的手术时间与更好的临床结局及降低的医院成本相关。
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