Dinges Christian, Steindl Johannes, Hitzl Wolfgang, Kiesslich Tobias, Seitelberger Rainald
Department of Cardiac Surgery, Paracelsus Medical University, Salzburger Landeskliniken, Salzburg, Austria.
Research Office (Biostatistics), Paracelsus Medical University, Salzburg, Austria.
Thorac Cardiovasc Surg. 2018 Jun;66(4):287-293. doi: 10.1055/s-0037-1599128. Epub 2017 Mar 4.
evidence-based medicine (EBM) approaches have reached broad acceptance, both in conservative and surgical disciplines. The aim of this study is to clarify the role of EBM in a rare condition of aortic regurgitation (AR) with surgical indication.
A purpose-built Internet-based questionnaire was sent to 607 cardiovascular surgeons in Germany, Austria, and Switzerland. A virtual 64-year-old patient's medical history was presented, including two ultrasound images and one computed tomography scan, showing a 58-mm aortic root aneurysm and a severe trileaflet regurgitant aortic valve. Participants had to choose their preferred therapeutic strategy from a list. Additionally, demographics including nationality, the center size, and the frequency of similar types of patients referred to their departments were collected.
Of 607 questionnaires, 100 were returned (16%). One participant was excluded due to conflicting answers. Most surgeons ( = 84; 84%) chose a valve-sparing root replacement (VSRR). A Bentall procedure was preferred by 13 surgeons (13%). Two surgeons voted for aortic valve replacement combined with partial root resection. The decision-making process was not significantly influenced by center size, nationality, or frequency of patients.
Applying the current guidelines to our virtual study patient, 84% of participants acted accordingly choosing VSRR. Remarkably, 14% of these surgeons see less than 10 and 43% see not more than 20 comparable patients per year. Since the guidelines reserve VSRR for competent centers, those numbers as well as the guidelines themselves should be further discussed.
循证医学（EBM）方法在保守治疗和外科领域均已得到广泛认可。本研究旨在阐明循证医学在一种具有手术指征的罕见主动脉瓣反流（AR）情况中的作用。
向德国、奥地利和瑞士的607名心血管外科医生发送了一份专门设计的基于互联网的问卷。呈现了一名虚拟64岁患者的病史，包括两张超声图像和一张计算机断层扫描，显示主动脉根部瘤直径为58毫米，三叶主动脉瓣重度反流。参与者必须从列表中选择他们首选的治疗策略。此外，还收集了包括国籍、中心规模以及转诊至其科室的类似类型患者频率等人口统计学信息。
607份问卷中，100份被退回（16%）。一名参与者因答案相互矛盾被排除。大多数外科医生（n = 84；84%）选择保留瓣膜的根部置换术（VSRR）。13名外科医生（13%）更倾向于Bentall手术。两名外科医生投票支持主动脉瓣置换术联合部分根部切除术。决策过程未受到中心规模、国籍或患者频率的显著影响。
将当前指南应用于我们的虚拟研究患者时，84%的参与者相应地选择了VSRR。值得注意的是，这些外科医生中有14%每年诊治的类似患者少于10例，43%每年诊治的类似患者不超过20例。由于指南将VSRR保留给有能力的中心，这些数字以及指南本身都应进一步讨论。
