The risks and benefits of reoperative aortic valve replacement
The risks and benefits of reoperative aortic valve replacement
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DOI：
10.1532/hsf98.20041005
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发表时间：
2004-01-01
影响因子：
0.6
通讯作者：
Wu, YX
中科院分区：
文献类型：
--
作者：
Gaudiani, VA;Grunkemeier, GL;Wu, YX
背景：许多患者被建议进行机械主动脉瓣置换术（AVR），因为其预期寿命超过组织假体的寿命。这种策略可以避免再次手术的风险，但使患者面临长期抗凝治疗的风险。哪种风险更大？方法：我们回顾了 1994 年至 2002 年接受治疗的 1213 名连续、未经选择的 AVR 患者的记录，其中 60% 进行了伴随手术。这些患者中，887 名是首次 AVR 患者，326 名接受了再次手术。在再次手术的患者中，134 名之前接受过 AVR（重做）。我们根据这 1213 例病例构建了一个风险模型，以评估预测死亡率的因素，并检查再手术对结果的影响程度。结果：多元逻辑回归分析表明，再手术和重做手术的因素不能预测死亡率。事实上，所有首次 AVR 手术的死亡率为 4.1%，所有再次 AVR 手术的死亡率为 3.1% (P =.891)。显着的预测因素（比值比）为再次手术透析（6.03）、术前休克（3.68）、纽约心脏协会 IV 级（2.20）、女性（1.76）、年龄（1.61）和心肺转流时间（1.26）。结论：在本系列中，再次手术 AVR 的风险与已发表的机械性心脏置换术后长期服用华法林钠（Coumadin）的风险相当。 AVR。建议任何需要 AVR 的成年人考虑组织假体。
Background: Many patients are advised to have mechanical aortic valve replacement (AVR) because their expected longevity exceeds that of tissue prostheses. This strategy may avoid the risks of reoperation but exposes patients to the risks of long-term anticoagulation therapy. Which risk is greater?Methods: We reviewed the records of 1213 consecutive, unselected AVR patients, 60% of whom had concomitant procedures, who were treated from 1994 through 2002. Of these patients, 887 were first-time AVR patients, and 326 underwent reoperation. Of the reoperation patients, 134 had previously undergone AVR ( redo). We constructed a risk model from these 1213 cases to assess the factors that predicted mortality and to examine the extent to which reoperation affected outcome.Results: Multiple logistic regression analysis indicated that factors of reoperation and redo operation did not predict mortality. In fact, the mortality rate was 4.1% for all first AVR operations and 3.1% for all reoperation AVR ( P =.891). Significant predicting factors ( with odds ratios) were reoperative dialysis (6.03), preoperative shock (3.68), New York Heart Association class IV (2.20), female sex (1.76), age (1.61), and cardiopulmonary bypass time (1.26).Conclusions: In this series, the risk of reoperation AVR is comparable with the published risks of long-term warfarin sodium ( Coumadin) administration after mechanical AVR. Any adult who requires AVR may be well advised to consider tissue prostheses.