小狗阅读会员会员
医学顶刊SCI精读工具

扫码登录小狗阅读

阅读SCI医学文献
Document
订阅泛读方向 订阅泛读期刊
  • 我的关注
  • 我的关注
  • {{item.title}}

    按需关注领域/方向,精准获取前沿热点

  • {{item.title}}

    {{item.follow}}人关注

  • {{item.subscribe_count}}人订阅

    IF:{{item.impact_factor}}

    {{item.title}}

Predictors of Long-Term Outcome of Isolated Surgical Aortic Valve Replacement in Aortic Regurgitation With Reduced Left Ventricular Ejection Fraction and Extreme Left Ventricular Dilatation.

孤立性外科主动脉瓣置换术治疗主动脉瓣反流伴左心室射血分数降低和左心室极度扩张的长期预后预测因素。

  • 影响因子:2.86
  • DOI:10.1016/j.amjcard.2020.01.041
  • 作者列表:"Dong N","Jiang W","Yin P","Hu X","Wang Y
  • 发表时间:2020-05-01
Abstract

:The management of severe aortic regurgitation (AR) in patients with reduced left ventricular function and extreme left ventricular dilatation presents a therapeutic dilemma. This study aims to assess risk factors of aortic valve replacement (AVR) for these particular population based on its performances. Two hundred twelve severe AR patients accompanied by left ventricular ejection fraction (LVEF) <50% and left ventricular end-diastolic dimension (LVEDD) ≥70 mm who underwent isolated AVR between January 2007 and December 2016 were identified retrospectively. Logistic regression and receiver operating characteristic were used to analyze prognostic indicators for in-hospital mortality while Kaplan-Meier analysis for long-term survival. Mean age was 56 ± 13 years with mean LVEF 40 ± 7% and LVEDD 78 ± 6 mm. In-hospital mortality rate was 7%, and survival rates at 5 and 10 years were 88 ± 4% and 73 ± 10%, respectively. Logistic regression analysis indicated in-hospital mortality was associated with preoperative age and LVEF. Receiver operating characteristic analysis showed LVEF = 35% was the best cut-off value at which to predict in-hospital death. Kaplan-Meier analysis revealed patients with markedly reduced LV function (LVEF <35%) had lower survival rates compared with other patients with moderate LV dysfunction (LVEF 36% to 50%) (1-, 5-, and 10-year: 90 ± 4%, 64 ± 7%, and 55 ± 14%, vs 97 ± 1%, 94 ± 3%, and 76 ± 7%, p <0.001). An age-matched analysis showed similar trend (p = 0.020). In Conclusion, AVR may be unsafe for severe AR patients with markedly reduced LV function (LVEF <35%) and extreme left ventricular dilatation (LVEDD >70 mm) due to poor postoperative early- and long-term outcomes.

摘要

: 在左心室功能降低和左心室极度扩张的患者中,严重主动脉瓣反流 (AR) 的处理呈现治疗困境。本研究旨在评估这些特定人群主动脉瓣置换术 (AVR) 的风险因素。回顾性分析2007年1月至2016年12月期间行孤立性AVR的50% 例伴有左心室射血分数 (LVEF) <70毫米和左心室舒张末期内径 (LVEDD) ≥ 的重度AR患者。采用Logistic回归和受试者操作特征分析院内死亡率的预后指标,同时采用Kaplan-Meier分析长期生存率。平均年龄为56 ± 13岁,平均LVEF为40 ± 7%,LVEDD为78 ± 6毫米。院内死亡率为7%,5年和10年生存率分别为88 ± 4% 和73 ± 10%。Logistic回归分析显示,住院死亡率与术前年龄和LVEF相关。受试者工作特征分析显示lvef   =   35% 是预测院内死亡的最佳截止值。Kaplan-Meier分析显示,LV功能显著降低 (LVEF <35%) 的患者与其他中度LV功能障碍患者 (LVEF 36% ~ 50%) 相比,生存率较低 (1年、5年和10年: 90 ± 4% 、64 ± 7% 和55 ± 14%,vs 97 ± 1%,94 ± 3%,和76 ± 7%,p <0.001)。年龄匹配分析显示相似的趋势 (p = 0.020)。总之,由于术后早期和长期预后差,AVR对于LV功能显著降低 (LVEF <35%) 和左心室极度扩张 (LVEDD> 70毫米) 的严重AR患者可能是不安全的。

关键词:
阅读人数:2人
下载该文献
小狗阅读

帮助医生、学生、科研工作者解决SCI文献找不到、看不懂、阅读效率低的问题。提供领域精准的SCI文献,通过多角度解析提高文献阅读效率,从而使用户获得有价值研究思路。

相关文献
影响因子:1.21
发表时间:2020-02-01
DOI:10.1007/s11748-019-01130-6
作者列表:["Kisamori E","Otani S","Yamamoto T","Nishiki M","Yamada Y","Matsumoto T"]

METHODS::Relapsing polychondritis is a rare multi-system disease characterized by inflammation in cartilaginous structures and other connective tissues. Cardiovascular complications occur in 10-51% of the patients. We report a case of concomitant aortic valve replacement, mitral valve replacement, and coronary artery bypass grafting in a patient with relapsing polychondritis. A 71-year-old female with relapsing polychondritis on prednisolone (5 mg/day) for 15 years presented at our hospital for further evaluation of valvular disease. Severe aortic stenosis and severe mitral regurgitation were diagnosed. We performed aortic and mitral valve replacement. During surgery, we found connective tissue surrounding the intima of the sinus of Valsalva and stenosis of the right coronary artery ostium, which was not noted on preoperative coronary angiography. We removed the tissue and performed bypass grafting to the right coronary artery. Postoperative recovery was uneventful, and she was discharged 27 days after surgery.

影响因子:1.52
发表时间:2020-03-01
DOI:10.1016/j.jtcvs.2019.03.089
作者列表:["Tang PC","Haft JW","Romano MA","Bitar A","Hasan R","Palardy M","Wu X","Aaronson KD","Pagani FD"]

METHODS:BACKGROUND:The effect of significant mitral regurgitation (MR) on outcomes after continuous flow left ventricular assist device (cfLVAD) implantation remains unclear. METHODS:We performed a retrospective review of prospectively collected data from 159 patients with preoperative severe MR who underwent cfLVAD implantation (2003-2017). Two-step cluster analysis using the log-likelihood distance for post-cfLVAD implantation parameters, which included right ventricular (RV) dysfunction, MR severity, and tricuspid regurgitation (TR) severity. Post-cfLVAD implantation echocardiographic parameters were obtained within the first month. RESULTS:Cluster analysis resulted in 3 groups. Group 1 (n = 67) had mild or less MR with moderate-severe RV dysfunction (RVD). Group 2 (n = 43) had moderate-severe MR with moderate-severe RVD. Group 3 (n = 49) had moderate MR with mild RVD. Group 2 had the largest proportion with Interagency Registry for Mechanically Assisted Circulatory Support score of 1 (30.2%) and 2 (41.9%). They were more likely to undergo temporary mechanical circulatory support (18.6%) and tricuspid valve procedure (62.8%). Group 2 had the highest rate of stroke (30.2%; P = .02), hemolysis (39.5%; P = .01), device thrombosis (30%; P = .01), and worst survival (46.5%; P = .01). Survival at 5 years for groups 1, 2, and 3 were 56.0%, 17.6%, and 55.8%. Regression analysis of the entire population showed that greater MR severity after cfLVAD was associated with RV failure (P < .05; odds ratio, 1.6) and RV assist device use (P = .09; odds ratio, 1.6). After excluding tricuspid valve repairs, MR severity had a positive correlation with TR severity (R = 0.33; P < .01). CONCLUSIONS:After cfLVAD implantation, moderate-severe MR and RVD predicted RV failure. Patients with preoperative moderate-severe MR and TR coupled with moderate-severe RVD might benefit the most from mitral and tricuspid valve intervention.

影响因子:2.15
发表时间:2020-03-01
DOI:10.1007/s40520-019-01228-0
作者列表:["Bo M","Bergamo D","Calvi E","Iacovino M","Falcone Y","Grisoglio E","Salizzoni S"]

METHODS:BACKGROUND:Among elderly with severe aortic stenosis (AS), Comprehensive Geriatric Assessment (CGA) originally contributed to address to transcatheter aortic valve implantation (TAVI) patients not suitable to surgical aortic valve replacement(SAVR). Nevertheless, TAVI has recently been proposed also in lower surgical risk patients. AIMS:To evaluate predictors of TAVI procedure and clinical outcomes among these patients. METHODS:For each patient ≥ 65 years with severe AS referring to our Cardiac Surgery Division, CGA was performed, including functional and cognitive status, comorbidity burden, frailty, nutritional status, gait speed, hand-grip strength and number of medications. Surgical risk was evaluated according to the Society of Thoracic Surgeons (STS) score (low-risk < 4%). Post-procedural outcomes (30-day survival and post-procedural complications) were obtained by medical records and a one-year follow-up assessed survival, and functional and cognitive performance. RESULTS:Among 154 subjects (mean age 82.9 years), 52 were at low-risk according to STS score. 32 patients were addressed to TAVI, 20 to SAVR. Variables significantly associated with TAVI-approach were lower gait speed (p 0.030) and higher number of medications (p 0.015). Short and long-term outcomes did not differ between groups. DISCUSSION:Among CGA variables, gait speed and number of medications were associated with the decision to perform TAVI instead of SAVR, even in patients at low surgical risk. 30-day and one-year survival and one-year functional and cognitive decline were similar between groups, despite a relevant prevalence of frailty in the TAVI group. CONCLUSIONS:We suggest that gait speed and number of medications should be considered in selecting appropriate candidates to TAVI among low surgical risk patients.

心脏瓣膜病方向

人的心脏有四个瓣膜,分别为二尖瓣、三尖瓣、主动脉瓣和肺动脉瓣。心脏瓣膜病就是指二尖瓣、三尖瓣、主动脉瓣和肺动脉瓣的瓣膜因风湿热、黏液变性、退行性改变、先天性畸形、缺血性坏死、感染或创伤等出现了病变,影响血流的正常流动,从而造成心脏功能异常,最终导致心力衰竭的单瓣膜或多瓣膜病变。随着人口老龄化加重,老年性瓣膜病以及冠心病、心肌梗死后引起的瓣膜病变也越来越常见。

复制标题
发送后即可在该邮箱或我的下载查看该文献
发送
该文献默认存储到我的下载

科研福利

临床科研之家订阅号

报名咨询

建议反馈
问题标题:
联系方式:
电子邮件:
您的需求: