IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open

Pub Date : 2024-09-01 DOI: 10.1016/j.cjco.2024.05.004

Background

Heart donation (HD) by those with death determination by circulatory criteria (DDCC) has been proposed as a method to increase the heart donor pool in response to the growing need for heart transplantation (HT). However, the potential level of HD after DDCC in the province of Québec has not yet been reported. This study aims to assess the suitability for HD among donors with DDCC, and to estimate its impact on HT activity.

Methods

Donation records by those with DDCC in the province of Québec, from January 2016 to December 2020, were retrospectively reviewed for donor and predonation characteristics. Predetermined exclusion criteria were used to evaluate eligibility for HD.

Results

Of the 122 patients with DDCC who were included, 42 (34%) were identified as potentially-eligible heart donors. The median age of potentially-eligible donors was 52 years; 60% were female; and the most prevalent causes leading to organ donation in this group were medical aid in dying (26%), traumatic brain injury (26%), and anoxia (24%). A 19% increase (42 of 225) in potential HT activity was estimated using strict criteria. In only one case did functional warm ischemia time exceed the 30-minute limit.

Conclusions

Using those with DDCC as a new source of heart donors can significantly increase the volume of heart donation in the province of Québec. Implementing an HD program for those with DDCC in Québec may reduce waiting time and increase the number of heart recipients.

背景根据循环标准（DDCC）确定死亡者的心脏捐献（HD）已被提议作为增加心脏捐献者库的一种方法，以应对日益增长的心脏移植（HT）需求。然而，魁北克省在 DDCC 之后的潜在 HD 水平尚未见报道。本研究旨在评估DDCC捐献者是否适合进行HD，并估计其对HT活动的影响。方法回顾性审查了魁北克省2016年1月至2020年12月期间DDCC捐献者的捐献记录，以了解捐献者和捐献前特征。结果在纳入的122名DDCC患者中，有42人（34%）被确定为潜在合格的心脏捐献者。潜在合格捐献者的年龄中位数为52岁；60%为女性；导致该组患者捐献器官的最常见原因是濒死医疗救助（26%）、创伤性脑损伤（26%）和缺氧（24%）。根据严格的标准估计，潜在的热休克活动增加了 19%（225 例中有 42 例）。结论将 DDCC 患者作为新的心脏捐献者来源可显著增加魁北克省的心脏捐献量。在魁北克省为 DDCC 患者实施血液透析计划可缩短等待时间并增加心脏受体的数量。

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引用次数: 0

Outcome of Percutaneous and Surgical Management for Tricuspid Infective Endocarditis: Insights From a National Study 经皮和手术治疗三尖瓣感染性心内膜炎的效果：一项全国性研究的启示

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open

Pub Date : 2024-09-01 DOI: 10.1016/j.cjco.2024.05.010

Background

The prevalence of infective endocarditis (IE) and its associated mortality rates remain high, despite medical advances. In recent years, treatment options for IE have expanded, but they are yet to be widely utilized. The current study aimed to compare in-hospital outcomes of high-risk tricuspid valve (TV) IE patients, by treatment strategy.

Methods

Patients from the National Inpatient Sample 2017-2019 database who had TV IE were grouped by therapy type—percutaneous aspiration, surgical, or conservative management. Patients were considered to be at high risk if they underwent mechanical intervention or if they had right ventricle failure or septic emboli.

Results

The analyzed cohort consisted of 28,495 patients—1.7% were treated with percutaneous aspiration, 13.5% with surgery, and 84.6% conservatively. Patients treated with percutaneous aspiration had the highest prevalence of septic shock and acute respiratory failure (P < 0.001). The overall in-hospital mortality rate was 7%. Patients treated conservatively had higher in-hospital mortality rates (7.5%) compared to those of the surgical group (4.4%) and the percutaneous aspiration group (4.1%; P < 0.001). In a multivariate analysis, conservative management was associated with an increased risk of in-hospital mortality (odds ratio 2.853, 95% confidence interval 1.748-4.659, P < 0.001), and no significant difference was found between the aspiration and surgical groups (P = 0.346). Benefits were pronounced in younger patients and those with septic shock or respiratory failure. Patients in the aspiration group had the highest rate of home discharge with self-care, of the various patient dispositions (P < 0.001).

Conclusions

Among high-risk patients with TV IE, an invasive approach is associated with a significantly lower in-hospital mortality rate than is a conservative approach, particularly in younger and unstable patients.

背景尽管医疗技术不断进步，但感染性心内膜炎（IE）的发病率及其相关死亡率仍然居高不下。近年来，IE的治疗方案不断增加，但尚未得到广泛应用。本研究旨在按治疗策略比较高风险三尖瓣（TV）IE患者的院内预后。方法将2017-2019年全国住院患者抽样数据库中的TV IE患者按治疗类型（经皮抽吸、手术或保守治疗）分组。如果患者接受了机械干预或出现右心室衰竭或化脓性栓子，则被视为高风险患者。结果分析的队列由28495名患者组成，其中1.7%接受了经皮穿刺抽吸治疗，13.5%接受了手术治疗，84.6%接受了保守治疗。采用经皮抽吸术治疗的患者中，脓毒性休克和急性呼吸衰竭的发生率最高（P < 0.001）。院内总死亡率为 7%。保守治疗患者的院内死亡率（7.5%）高于手术组（4.4%）和经皮抽吸组（4.1%；P < 0.001）。在多变量分析中，保守治疗与院内死亡风险增加有关（几率比2.853，95%置信区间1.748-4.659，P <0.001），抽吸组和手术组之间没有发现显著差异（P = 0.346）。年轻患者和脓毒性休克或呼吸衰竭患者获益明显。结论在 TV IE 的高危患者中，侵入性方法的院内死亡率明显低于保守性方法，尤其是在年轻和病情不稳定的患者中。

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引用次数: 0

Acute Coronary Syndrome in a 40-Year-Old Man with Triglyceride Deposit Cardiomyovasculopathy: A Case Report 一名 40 岁男性甘油三酯沉积性心肌病患者的急性冠状动脉综合征：病例报告

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open

Pub Date : 2024-09-01 DOI: 10.1016/j.cjco.2024.06.004

引用次数: 0

Long-term Monitoring to Detect Risk of Sudden Cardiac Death in Inherited Arrhythmia Patients 长期监测遗传性心律失常患者的心脏性猝死风险

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open

Pub Date : 2024-09-01 DOI: 10.1016/j.cjco.2024.05.007

Background

Risk stratification in inherited arrhythmia syndromes is challenging. Implantable cardioverter defibrillators (ICDs) are effective in the prevention of sudden cardiac death but are associated with significant complications. We aimed to determine the value of long-term implantable loop recorder (ILR) monitoring to determine risk factors for arrhythmias in inherited arrhythmia patients.

Methods

We conducted a prospective multicentre study between 2015 and 2020 recruiting inherited arrhythmia probands and family members at intermediate arrhythmic risk, with no class 1 indication for ICD implantation. The primary endpoint was the detection by ILR of nonsustained ventricular tachycardia over ≥ 10 consecutive beats. Secondary endpoints included ICD insertion during follow-up, all-cause mortality, and ILR complication rates.

Results

A total of 45 individuals (30 female participants) were enrolled in the study. The most common diagnoses were long-QT syndrome (28%), Brugada syndrome (26%), and arrhythmogenic cardiomyopathy (11%). Following ILR insertion (mean follow-up 633 days; range, 387-969), cardiac symptoms occurred in 19 of 45 patients (42%), 5 of whom had nonsustained ventricular tachycardias (11%), which were symptomatic in 3 individuals. This situation led to ICD implantation based on ILR in 5 of 45 patients (11%). Fifty percent of symptomatic events occurred in ARVC patients. The median time from ILR insertion to ICD implantation was 152 days (interquartile range (25th, 75th percentiles) 55 of 209). No patient experienced sudden cardiac death.

Conclusions

ILRs enable the detection of high-risk arrhythmic features and facilitate selection of ICD candidates in inherited arrhythmia patients with borderline indications.

背景遗传性心律失常综合征的风险分层具有挑战性。植入式心律转复除颤器（ICD）能有效预防心脏性猝死，但也会带来严重的并发症。我们旨在确定长期植入式环路记录器（ILR）监测对确定遗传性心律失常患者心律失常风险因素的价值。方法我们在 2015 年至 2020 年期间开展了一项前瞻性多中心研究，招募了处于中度心律失常风险的遗传性心律失常疑似患者和家庭成员，他们没有 ICD 植入的 1 类适应症。主要终点是通过 ILR 检测到连续≥10 次的非持续性室速。次要终点包括随访期间的 ICD 植入情况、全因死亡率和 ILR 并发症发生率。最常见的诊断为长 QT 综合征（28%）、Brugada 综合征（26%）和致心律失常性心肌病（11%）。植入 ILR 后（平均随访 633 天；范围：387-969），45 名患者中有 19 人（42%）出现心脏症状，其中 5 人出现非持续性室性心动过速（11%），3 人出现症状。在这种情况下，45 名患者中有 5 人（11%）根据 ILR 植入了 ICD。50%的症状性事件发生在 ARVC 患者身上。从植入 ILR 到植入 ICD 的中位时间为 152 天（四分位距（第 25、75 百分位数）为 55，共 209 天）。结论 ILR 能够检测高危心律失常特征，有助于为有边缘适应症的遗传性心律失常患者选择 ICD 候选者。

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引用次数: 0

Prevalence, Patient Awareness, Treatment, and Control of Hypertension in Canadian Adults With Common Comorbidities 患有常见并发症的加拿大成年人的高血压患病率、患者意识、治疗和控制情况

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open

Pub Date : 2024-09-01 DOI: 10.1016/j.cjco.2024.05.012

Background

Whether certain medical conditions are associated with blood pressure (BP) treatment and control is unclear.

Methods

Using the Canadian Health Measures Survey (2007-2019), BP was assessed according to the presence of selected comorbidities, including prior heart attack or stroke, dyslipidemia, chronic kidney disease, diabetes mellitus, obstructive sleep apnea, and overweight or obesity.

Results

A total of 5,841,453 people, representing 23.0% (95% confidence interval [CI] 21.7%-24.2%) of Canadian adults, were hypertensive. The adjusted odds ratio (aOR) of having hypertension treated and controlled was higher in people with the following conditions, as compared to people without these conditions: a prior heart attack or stroke (aOR 3.15; 95% CI 2.31-4.31); dyslipidemia (aOR 2.51; 95% CI 1.96-3.21); obstructive sleep apnea (aOR 1.95; 95% CI 1.19-3.21); overweight or obesity (aOR 1.51; 95% CI 1.18-1.94); chronic kidney disease (aOR 1.49; 95% CI 1.13-1.95); and diabetes (aOR 1.44; 95% CI 1.12-1.86). Individuals without any of these comorbidities were less likely to have BP that is treated and controlled (aOR 0.34; 95% CI 0.25-0.48). Moreover, the prevalence of BP treatment and control was low among many people without prior heart attack or stroke, even those with a moderate (aOR 0.25; 95% CI 0.17-0.37) or high (aOR 0.10; 95% CI 0.06-0.16) Framingham risk.

Conclusions

Large differences in levels of BP control exist across comorbidity profiles, and the greatest gaps are seen in individuals without recognized comorbidities, even those who have a moderate-to-high Framingham risk. Efforts to optimize BP control and narrow care gaps, especially in individuals without recognized comorbidities, are necessary to reduce the burden of cardiovascular disease and premature death in Canada.

背景某些疾病是否与血压（BP）的治疗和控制有关尚不清楚。方法利用加拿大健康措施调查（2007-2019 年），根据是否存在某些合并症（包括既往心脏病发作或中风、血脂异常、慢性肾病、糖尿病、阻塞性睡眠呼吸暂停、超重或肥胖）来评估血压。结果共有 5,841,453 人患有高血压，占加拿大成年人的 23.0%（95% 置信区间 [CI] 21.7%-24.2%）。与不存在以下情况的人相比，存在以下情况的人接受治疗并控制高血压的调整赔率（aOR）较高：曾患心脏病或中风（aOR 3.15；95% CI 2.31-4.31）；血脂异常（aOR 3.15；95% CI 2.31-4.31）。31）、血脂异常（aOR 2.51；95% CI 1.96-3.21）、阻塞性睡眠呼吸暂停（aOR 1.95；95% CI 1.19-3.21）、超重或肥胖（aOR 1.51；95% CI 1.18-1.94）、慢性肾病（aOR 1.49；95% CI 1.13-1.95）和糖尿病（aOR 1.44；95% CI 1.12-1.86）。没有上述任何一种合并症的人，其血压得到治疗和控制的可能性较低（aOR 0.34；95% CI 0.25-0.48）。此外，在许多既往没有心脏病发作或中风的人群中，即使是那些具有中度（aOR 0.25；95% CI 0.17-0.37）或高度（aOR 0.10；95% CI 0.06-0.16）弗明翰风险的人群，血压治疗和控制的普及率也很低。要减轻加拿大心血管疾病和过早死亡的负担，就必须努力优化血压控制并缩小护理差距，尤其是在没有公认合并症的人群中。

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引用次数: 0

Time to Calm the Fick Down? A Systematic Review and Meta-Analysis of Thermodilution Compared to Direct Fick in Tricuspid Regurgitation 是时候让 Fick 平静下来了吗？三尖瓣反流中热稀释法与直接菲克法相比较的系统回顾和元分析

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open

Pub Date : 2024-09-01 DOI: 10.1016/j.cjco.2024.05.008

Background

Many clinicians consider thermodilution (TD) as a means to measure cardiac output (CO) to be unreliable in patients with tricuspid regurgitation (TR). No systematic appraisals of this clinical issue have been conducted. We hypothesized that the level of inaccuracy of using TD in patients with TR, compared to the direct Fick (DF) method, to determine CO, is overstated.

Methods

We performed a systematic search of 6 major literature databases for the period from 1946 to July 2023. Studies were included if they included CO measurements determined with both TD and the DF method in patients with vs without TR. Meta-analysis of the correlation between the measurements determined by TD vs the DF method was performed, stratified by the presence of TR.

Results

A total of 1064 studies were identified, of which 8 met the inclusion criteria. Four of the studies were included in the pooled analysis. The presence of TR did not affect the correlation between CO measurements determined by TD vs the DF method (moderate-to-severe TR: r = 0.90, 95% confidence interval 0.76, 0.96; mild or no TR, r = 0.86, 95% confidence interval 0.71, 0.93). Many studies had high levels of heterogeneity and risk of bias.

Conclusions

The accuracy of CO measurements made using TD, compared to the gold-standard DF method, may not be meaningfully affected by the presence of moderate-to-severe TR. Given the high levels of heterogeneity and risk of bias of the included studies, these findings should be replicated in a modern cohort.

背景许多临床医生认为热稀释（TD）作为一种测量三尖瓣反流（TR）患者心输出量（CO）的方法并不可靠。目前尚未对这一临床问题进行系统评估。我们假设，与直接菲克（DF）法相比，在 TR 患者中使用 TD 测定 CO 的不准确程度被夸大了。方法我们对 1946 年至 2023 年 7 月期间的 6 个主要文献数据库进行了系统检索。如果研究纳入了同时使用 TD 和 DF 方法测定的 CO 测量值，且研究对象为有 TR 和无 TR 的患者，则纳入研究。根据是否存在 TR，对 TD 与 DF 方法测定值之间的相关性进行了 Meta 分析。结果共发现 1064 项研究，其中 8 项符合纳入标准。其中四项研究被纳入汇总分析。TR的存在并不影响TD法与DF法测定的CO测量值之间的相关性（中度至重度TR：r = 0.90，95%置信区间为0.76，0.96；轻度或无TR，r = 0.86，95%置信区间为0.71，0.93）。结论与黄金标准的 DF 方法相比，使用 TD 测量 CO 的准确性可能不会受到中重度 TR 的影响。考虑到所纳入研究的高度异质性和偏倚风险，这些研究结果应在现代队列中重复。

{"title":"Time to Calm the Fick Down? A Systematic Review and Meta-Analysis of Thermodilution Compared to Direct Fick in Tricuspid Regurgitation","authors":"","doi":"10.1016/j.cjco.2024.05.008","DOIUrl":"10.1016/j.cjco.2024.05.008","url":null,"abstract":"<div><h3>Background</h3><p>Many clinicians consider thermodilution (TD) as a means to measure cardiac output (CO) to be unreliable in patients with tricuspid regurgitation (TR). No systematic appraisals of this clinical issue have been conducted. We hypothesized that the level of inaccuracy of using TD in patients with TR, compared to the direct Fick (DF) method, to determine CO, is overstated.</p></div><div><h3>Methods</h3><p>We performed a systematic search of 6 major literature databases for the period from 1946 to July 2023. Studies were included if they included CO measurements determined with both TD and the DF method in patients with vs without TR. Meta-analysis of the correlation between the measurements determined by TD vs the DF method was performed, stratified by the presence of TR.</p></div><div><h3>Results</h3><p>A total of 1064 studies were identified, of which 8 met the inclusion criteria. Four of the studies were included in the pooled analysis. The presence of TR did not affect the correlation between CO measurements determined by TD vs the DF method (moderate-to-severe TR: <em>r</em> = 0.90, 95% confidence interval 0.76, 0.96; mild or no TR, <em>r</em> = 0.86, 95% confidence interval 0.71, 0.93). Many studies had high levels of heterogeneity and risk of bias.</p></div><div><h3>Conclusions</h3><p>The accuracy of CO measurements made using TD, compared to the gold-standard DF method, may not be meaningfully affected by the presence of moderate-to-severe TR. Given the high levels of heterogeneity and risk of bias of the included studies, these findings should be replicated in a modern cohort.</p></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589790X24002191/pdfft?md5=6f931b75f8dde0578b1551625196e48d&pid=1-s2.0-S2589790X24002191-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141134974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Approach to Right-Sided Chamber Dilatation in Cardiac Shunts: Part 1 of a 2-Part Series 心脏分流术中右侧心腔扩张的方法：两部分系列之第一部分

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open

Pub Date : 2024-09-01 DOI: 10.1016/j.cjco.2024.06.005

引用次数: 0

Novel Noninvasive Index Combining Echocardiography and Computed Tomography for Screening for Pulmonary Hypertension in Patients With Systemic Sclerosis 结合超声心动图和计算机断层扫描筛查系统性硬化症肺动脉高压的新型无创指标

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open

Pub Date : 2024-09-01 DOI: 10.1016/j.cjco.2024.05.005

Background

In patients with systemic sclerosis (SSc), early detection of pulmonary hypertension (PH) improves survival. This study aimed to investigate whether a combination index (cPAT) of the tricuspid regurgitation jet peak gradient and the ratio of pulmonary artery (PA) diameter to aortic diameter measured by computed tomography (CT; PA ratio) can estimate the mean PA pressure (mPAP) and detect PH more accurately than conventional parameters in SSc patients.

Methods

A total of 36 SSc patients who underwent PH screening were retrospectively analyzed. All patients were screened for PH between 2013 and 2017 by echocardiography, CT, and right heart catheterization. Patients with mPAP > 20 mm Hg by right heart catheterization were diagnosed as having PH. Additionally, patients with an mPAP > 20 mm Hg, pulmonary vascular resistance > 2 Wood units, and PA wedge pressure ≤ 15 mm Hg, for whom other causes were ruled out, including group 2-5, were defined as having pulmonary atrial hypertension.

Results

Of 36 patients, 29 patients were female (81%), and the average duration of SSc was 7.5 years. The mPAP was significantly correlated with the tricuspid regurgitation jet peak gradient (r = 0.734), the PA ratio (r = 0.584), and the cPAT (r = 0.848). In receiver operating characteristic analysis to identify PH, the cPAT showed the highest area under the curve, 0.906, among the 3 parameters. Additionally, in receiver operating characteristic analysis to identify pulmonary atrial hypertension, the cPAT also showed the highest area under the curve, 0.851, among the 3 parameters.

Conclusions

The cPAT is a new index combining echocardiogram and CT results that provides the most accurate noninvasive assessment of mPAP in SSc patients. The cPAT can also help detect PH early in SSc patients, thereby allowing for earlier treatment.

背景在系统性硬化症（SSc）患者中，早期发现肺动脉高压（PH）可提高生存率。本研究旨在探讨三尖瓣反流喷射峰梯度和计算机断层扫描（CT；PA ratio）测量的肺动脉（PA）直径与主动脉直径的比值的组合指数（cPAT）是否能比传统参数更准确地估算出SSc患者的平均肺动脉压力（mPAP）并检测出PH。所有患者均在2013年至2017年期间通过超声心动图、CT和右心导管检查进行了PH筛查。通过右心导管检查发现 mPAP > 20 mm Hg 的患者被诊断为 PH。此外，mPAP > 20 mm Hg、肺血管阻力 > 2 Wood单位、PA楔压≤15 mm Hg且排除其他原因（包括第2-5组）的患者被定义为肺动脉高压。mPAP 与三尖瓣反流喷射峰梯度（r = 0.734）、PA 比值（r = 0.584）和 cPAT（r = 0.848）明显相关。在识别 PH 的接收器操作特征分析中，cPAT 在 3 个参数中显示出最高的曲线下面积（0.906）。结论 cPAT 是一种结合超声心动图和 CT 结果的新指标，可对 SSc 患者的 mPAP 进行最准确的无创评估。cPAT 还有助于早期发现 SSc 患者的 PH，从而及早进行治疗。

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引用次数: 0

Sex Disparities in the Use and Outcomes of Septal Reduction Therapies for Obstructive Hypertrophic Cardiomyopathy 阻塞性肥厚型心肌病室间隔缩窄疗法的使用和疗效方面的性别差异

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open

Pub Date : 2024-09-01 DOI: 10.1016/j.cjco.2024.05.013

Background

Data are limited that examine potential sex-based disparities in the utilization and complications of septal reduction therapy (SRT) in patients with obstructive hypertrophic cardiomyopathy. Our aim was to assess the use and in-hospital outcomes of SRT, according to sex. We performed a retrospective cohort study using the 2017-2019 National Inpatient Sample database. Adult patients with obstructive hypertrophic cardiomyopathy were identified.

Methods

We assessed the use of SRT (surgical septal myectomy and alcohol septal ablation), according to sex. In those who underwent SRT, rates of in-hospital mortality, pacemaker implantation, implantable cardioverter defibrillator (ICD) implantation, ischemic stroke, major bleeding, and pericardial complication were assessed. All outcomes were compared between groups using inverse probability of treatment weighting (IPTW), adjusting for demographics, comorbidity burden, and hospital characteristics.

Results

In total, 72,680 weighted hospitalizations (median age: 67 years [range: 57-77]; 61% female patients) were included, and only 5.9% of patients underwent SRT. After IPTW adjustment, female patients were more likely to undergo SRT (adjusted risk ratio [aRR] 1.18, 95% confidence interval [95% CI] 1.03-1.36) and alcohol septal ablation (aRR 1.38, 95% CI 1.04-1.83). Likewise, female patients received pacemaker implantation more often (aRR 1.96, 95% CI 1.10-3.50) and ICD implantation (aRR 0.58, 95% CI 0.34-0.99) less frequently, compared with male patients. No differences were present in rates of surgical septal myectomy, in-hospital mortality, ischemic stroke, major bleeding, and pericardial complication between groups.

Conclusions

Our results suggest that female patients were slightly more likely to undergo SRT, especially alcohol septal ablation. In-hospital mortality and postprocedural complications were similar between the sexes, but women received more pacemaker implantation and less ICD implantation.

背景研究阻塞性肥厚型心肌病患者在使用室间隔减容疗法（SRT）和并发症方面可能存在的性别差异的数据非常有限。我们的目的是根据性别评估 SRT 的使用情况和院内预后。我们利用 2017-2019 年全国住院患者样本数据库进行了一项回顾性队列研究。方法我们根据性别评估了SRT（外科室间隔肌切除术和酒精室间隔消融术）的使用情况。我们评估了接受 SRT 的患者的院内死亡率、起搏器植入率、植入式心律转复除颤器（ICD）植入率、缺血性中风率、大出血率和心包并发症率。结果共纳入了 72,680 例加权住院病例（中位年龄：67 岁 [范围：57-77]；61% 为女性患者），只有 5.9% 的患者接受了 SRT 治疗。经过 IPTW 调整后，女性患者更有可能接受 SRT（调整风险比 [aRR] 1.18，95% 置信区间 [95% CI] 1.03-1.36）和酒精隔消融术（aRR 1.38，95% CI 1.04-1.83）。同样，与男性患者相比，女性患者接受起搏器植入术的频率更高（aRR 1.96，95% CI 1.10-3.50），接受 ICD 植入术的频率更低（aRR 0.58，95% CI 0.34-0.99）。结论我们的研究结果表明，女性患者接受 SRT 的几率略高，尤其是酒精室间隔消融术。男女患者的院内死亡率和术后并发症相似，但女性接受起搏器植入术的较多，接受 ICD 植入术的较少。

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引用次数: 0

Total Arch vs Hemiarch Repair in Acute Type A Aortic Dissection: Systematic Review and Meta-Analysis of Comparative Studies 急性 A 型主动脉夹层中的全弓与半弓修复术：比较研究的系统回顾和元分析

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open

Pub Date : 2024-09-01 DOI: 10.1016/j.cjco.2024.04.012

Background

We aimed to compare the short- and long-term outcomes of total arch replacement (TAR) vs hemiarch replacement (HAR) in the management of acute type A aortic dissection.

Methods

We searched the literature for studies directly comparing TAR to HAR in acute type A aortic dissection. Hazard ratios (HRs) were extracted from digitized Kaplan-Meier curves.

Results

A total of 6526 patients were identified, of which 2060 (32%) had received a TAR. A total of 37% of patients were female, and the mean age (standard deviation) of the cohort was 59.8 ± 11.8 years. TAR patients had a higher prevalence of preoperative malperfusion (34% vs 26%). The TAR group had higher odds of 30-day mortality (4404 patients; odds ratio [OR] 1.79, 95% confidence interval [CI] 1.29-2.49), renal failure requiring dialysis (3475 patients; OR 1.34, 95% CI 1.02-1.76), and a trend toward higher rates of stroke (3292 patients; OR 1.49, 95% CI 0.93-2.39). No significant differences were observed in prevalence of permanent spinal cord injury, visceral ischemia, or reoperation for bleeding. The TAR group had a non–statistically significant increase in long-term mortality (4408 patients; HR 1.25, 95% CI 0.99-1.57), but showed a trend toward improved freedom from long-term aortic reoperation (1359 patients; HR 0.53; 95% CI 0.18-1.59). In a subgroup analysis, the hazard ratio of long-term mortality favoured TAR in only the subgroup of studies in which the difference in malperfusion was > 10% between groups.

Conclusions

TAR could be associated with improved freedom from long-term aortic reoperation but with potentially increased perioperative risks. We recommend a tailored surgical approach.

背景我们旨在比较全弓置换术（TAR）与半弓置换术（HAR）在治疗急性A型主动脉夹层中的短期和长期疗效。结果共发现 6526 例患者，其中 2060 例（32%）接受了 TAR。37%的患者为女性，平均年龄（标准差）为 59.8 ± 11.8 岁。TAR患者术前灌注不良的发生率更高（34% 对 26%）。TAR组患者的30天死亡率（4404例患者；比值比[OR]1.79，95%置信区间[CI]1.29-2.49）、需要透析的肾衰竭（3475例患者；比值比1.34，95%置信区间[CI]1.02-1.76）和中风发生率呈上升趋势（3292例患者；比值比1.49，95%置信区间[CI]0.93-2.39）。在永久性脊髓损伤、内脏缺血或因出血再次手术的发生率方面没有观察到明显差异。TAR 组的长期死亡率（4408 例患者；HR 1.25，95% CI 0.99-1.57）增加无统计学意义，但主动脉长期再手术率有改善趋势（1359 例患者；HR 0.53；95% CI 0.18-1.59）。在亚组分析中，只有在研究组间灌注不良率差异为 10%的亚组中，长期死亡率的危险比更倾向于 TAR。我们建议采用量身定制的手术方法。

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引用次数: 0