JACC:Ross手术的预后明显优于生物瓣膜AVR!

2022-03-12 Nebula MedSci原创

Ross手术与更好的长期生存率和无不良瓣膜相关事件相关,仍是接受AVR的中青年患者的首要选择

长期以来,机械假体一直是年轻和中年人主动脉瓣置换术 (AVR) 的首选选择。但是在过去的20年里,在这一患者群体中生物瓣膜的使用率显著升高。这一趋势源于希望避免机械AVR要求的终生抗凝治疗及其相关并发症。

Ross手术是一种更复杂的手术,外科医生用患者自体肺动脉瓣替换主动脉瓣,这是正常主动脉瓣的镜像。近日,《J Am Coll Cardiol》杂志上新发表了一项研究,对比了进行Ross手术与接受生物主动脉瓣置换术(AVR)的患者的长期预后。

研究人员筛查了1990年至2014年期间在多伦多总医院接受Ross手术或手术生物瓣AVR的16-60岁的患者。主要分析接受两种治疗的患者的全因死亡率(主要终点);此外还对比了两组患者的瓣膜再介入、瓣膜恶化、心内膜炎、血栓栓塞事件和永久性起搏器植入情况(次要终点)。

两组患者的全因死亡率

通过倾向评分匹配到了108对患者(中位年龄41岁:范围34-47岁)。两组间的基线特征相似。两组均无手术死亡病人。平均随访了14.5±7.2年。Ross手术后的全因死亡率较低(HR 0.35, p=0.028)。将死亡作为竞争风险,Ross手术组的再介入(HR 0.21, p<0.001)、瓣膜恶化(HR 0.25, p<0.001)、血栓栓塞事件(HR 0.15, p=0.002)和永久起搏器植入(HR 0.22, p=0.006)的发生率均更低。

两组患者的再介入率

在这项倾向匹配研究中,与生物人工瓣膜AVR相比,Ross手术与更好的长期生存率和无不良瓣膜相关事件相关。总之,Ross手术仍是接受AVR的中青年患者的首要选择

原始出处:

Mazine Amine,David Tirone E,Stoklosa Klaudiusz et al. Improved Outcomes Following the Ross Procedure Compared With Bioprosthetic Aortic Valve Replacement.[J] .J Am Coll Cardiol, 2022, 79: 993-1005.

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    2022-09-04 hbwxf
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    2022-03-14 lsndxfj
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