Jansen Klomp Wouter W, Moons Carl G M, Nierich Arno P, Brandon Bravo Bruinsma George J, Van't Hof Arnoud W J, Grandjean Jan G, Peelen Linda M
Department of Cardiology, Isala, Dokter van Heesweg 2, 8025 AB Zwolle, Netherlands.
Department of Clinical Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, Netherlands.
Int J Vasc Med. 2017;2017:1857069. doi: 10.1155/2017/1857069. Epub 2017 Sep 11.
The aim of this study was to investigate the impact of perioperative screening with modified transesophageal echocardiography (A-View method). We compared, in consecutive patients who underwent cardiac surgery between 2006 and 2014, 30-day mortality and in-hospital stroke incidence, operated either with perioperative modified TEE screening (intervention group) or only with conventional TEE screening (control group). Of the 8,605 study patients, modified TEE was applied in 1,391 patients (16.2%). Patients in the intervention group were on average older (71 versus 68 years, < 0.001) and more often females (31.0% versus 28.0%, < 0.001) and had a higher predicted mortality (EuroSCORE I: 5.9% versus 4.0%, < 0.001). The observed 30-day mortality was 2.2% and 2.5% in both groups, respectively, with multivariable and propensity-score adjusted relative risks (RRs) of 0.70 (95% CI: 0.50-1.00, = 0.05) and 0.67 (95% CI: 0.45-0.98, = 0.04). In-hospital stroke was 2.9% and 2.1% in both groups, respectively, with adjusted RRs of 1.03 (95% CI: 0.73-1.45) and 1.01 (95% CI: 0.71-1.43). In patients undergoing cardiac surgery, use of perioperative screening for aortic atherosclerosis with modified TEE was associated with lower postoperative mortality, but not stroke, as compared to patients operated on without such screening.
本研究的目的是调查采用改良经食管超声心动图（A-View法）进行围手术期筛查的影响。我们比较了2006年至2014年间接受心脏手术的连续患者，其中一组采用围手术期改良经食管超声心动图筛查（干预组），另一组仅采用传统经食管超声心动图筛查（对照组），比较两组的30天死亡率和住院期间卒中发生率。在8605例研究患者中，1391例（16.2%）应用了改良经食管超声心动图。干预组患者平均年龄更大（71岁对68岁，P<0.001），女性比例更高（31.0%对28.0%，P<0.001），预测死亡率更高（欧洲心脏手术风险评估系统I：5.9%对4.0%，P<0.001）。两组观察到的30天死亡率分别为2.2%和2.5%，多变量和倾向评分调整后的相对风险（RR）分别为0.70（95%CI：0.50-1.00，P=0.05）和0.67（95%CI：0.45-0.98，P=0.04）。两组住院期间卒中发生率分别为2.9%和2.1%，调整后的RR分别为1.03（95%CI：0.73-1.45）和1.01（95%CI：0.71-1.43）。与未进行此类筛查的心脏手术患者相比，采用改良经食管超声心动图对主动脉粥样硬化进行围手术期筛查的心脏手术患者术后死亡率较低，但卒中发生率无差异。
