What are the characteristics of patients with severe, symptomatic, mitral regurgitation who are denied surgery?
What are the characteristics of patients with severe, symptomatic, mitral regurgitation who are denied surgery?
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DOI：
10.1093/eurheartj/ehm001
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发表时间：
2007-06-01
影响因子：
39.3
通讯作者：
Vahanian, Alec
中科院分区：
文献类型：
--
作者：
Mirabel, Mariana;Iung, Bernard;Vahanian, Alec
目的确定严重症状性二尖瓣反流（MR）患者的比例和特点，谁被拒绝surgical.Methods和结果在欧洲心脏调查心脏瓣膜病，396例患者有严重症状性二尖瓣反流多普勒超声心动图（等级>= 3/4）和纽约心脏协会11级或更高。根据是否手术的决定分析患者特征。193名患者（49%）决定不手术。在多变量分析中，左心室射血分数（LVEF）降低[OR= 1.39/10%降低，95%CI（1.17-1.66），P = 0.0002]，非缺血性病因[OR = 4.44，95% CI（1.96-10.76），P = 0.0006]，年龄较大[OR = 1.40/10年增加，95% CI（1.15-1.72），P=0.001]，Charlson合并症指数增加[OR= 1.38/1分增加，95% CI（1.12-1.72），P = 0.004]和3级MR [OR = 2.23，95% CI（1.28-3.29），P = 0.005]与不手术的决定相关。一年生存率为96.0 +/- 1.4%的患者与积极的干预决策与89.5 +/- 2.3%的那些与一个否定的决策（P = 0.02）。结论手术被拒绝在49%的严重症状性MR患者。损害LVEF，年龄较大，合并症是最显着的特点，患者谁被拒绝手术。根据目前的知识，年龄和LVEF在决策中的权重似乎不合理。
Aim To identify the proportion and characteristics of patients with severe symptomatic mitral regurgita tion (MR) who are denied surgery.Methods and results In the Euro Heart Survey on valvular heart disease, 396 patients had severe symptomatic MR as assessed by Doppler-echocardiography (grade >= 3/4) and New York Heart Association class 11 or greater. Patient characteristics were analysed according to the decision to operate or not. A decision not to operate was taken in 193 patients (49%). In multivariable analysis, decreased left ventricular ejection fraction (LVEF) [OR= 1.39 per 10% decrease, 95% CI (1.17-1.66), P = 0.0002], non-ischaemic aetiology [OR = 4.44, 95% CI (1.96-10.76), P = 0.0006], older age [OR = 1.40 per 10-year increase, 95% CI(1.15-1.72), P=0.001], increased Charlson comorbidity index [OR= 1.38 per 1 point increase, 95% CI (1.12-1.72), P = 0.004], and grade 3 MR [OR = 2.23, 95% CI (1.28-3.29), P = 0.005] were associated with the decision not to operate. One-year survival was 96.0 +/- 1.4% in patients with a positive decision for intervention vs. 89.5 +/- 2.3% in those with a negative decision (P = 0.02).Conclusion Surgery was denied in 49% of patients with severe symptomatic MR. Impaired LVEF, older age, and comorbidity were the most striking characteristics of patients who were denied surgery. The weight of age and LVEF in the decision do not seem justified according to current knowledge.