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Better Late Than Never - A Case of a Congenital Left Partial Anomalous Pulmonary Venous Drainage Diagnosed and Treated in The Sixth Decade of Life. 迟做总比不做好——先天性左偏性肺静脉引流1例,60岁诊断治疗。
IF 0.6 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-03-13 DOI: 10.1532/hsf.5273
Mohamed Elbayomi, P Pathare, E Nooh, F Harig, F Abdullayev, M Weyand

Partial anomalous pulmonary venous drainage (PAPVD) is a relatively uncommon cardiac anomaly. The diagnosis might be challenging as are the presenting symptoms. Its clinical course mimics more familiar diseases, e.g., pulmonary artery embolism. We present a case of PAPVD, which had been misdiagnosed for more than two decades. After establishing the correct diagnosis, the patient got his congenital anomaly surgically corrected and showed excellent cardiac recovery in the six months follow up.

部分肺静脉异常引流(PAPVD)是一种相对少见的心脏异常。诊断可能是具有挑战性的,因为是目前的症状。其临床过程类似于更常见的疾病,如肺动脉栓塞。我们提出一个病例PAPVD,已被误诊超过二十年。在正确诊断后,患者手术矫正了先天性异常,并在6个月的随访中表现出良好的心脏恢复。
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引用次数: 0
Prevalence of Coronary Artery Disease in Patients Undergoing Valvular Heart Surgery. 心脏瓣膜手术患者冠状动脉疾病的患病率
IF 0.6 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-03-03 DOI: 10.1532/hsf.5331
Changwei Ren, Jianbo Yu, Jinwei Zhang, Shengwei Wang, Enjun Zhu, Hongchang Guo, Dingce Sun, Bing Tang, Hao Cui, Yongqiang Lai

Background: The risk of coronary artery disease (CAD) in different valve dysfunction has been unclear.

Methods: We reviewed patients, who underwent valve heart surgery and coronary angiography from 2008 to 2021, at our center.

Results: A total of 7,932 patients were included in the present study, and 1,332 (16.8%) had CAD. The mean age of the study cohort was 60.5±7.9 years, and 4,206 (53.0%) were male. CAD was 21.4% in aortic disease, 16.2% in mitral valve disease, 11.8% in isolated tricuspid valve disease, and 13.0% in combined aortic and mitral valve disease. Patients with aortic stenosis were older than those with regurgitation (63.6±7.4 years vs. 59.5±8.2 years, P < 0.001), and the CAD risks also were higher (28.0% vs. 19.2%, P < 0.001). The age difference was minimal (60.6±8.2 years vs. 59.5±6.7 years, P = 0.002) between patients with mitral valve regurgitation and stenosis, but the risks of CAD were twice high in regurgitation (20.2% vs. 10.5%, P < 0.001). When the type of valve impairment was not considered, non-rheumatic etiology, advanced age, male sex, hypertension, and diabetes were independent predictors of CAD.

Conclusion: In patients undergoing valve surgery, the prevalence of CAD was influenced by conventional risk factors. Importantly, CAD also was associated with the type and etiology of valve diseases.

背景:不同瓣膜功能障碍的冠状动脉疾病(CAD)风险尚不清楚。方法:我们回顾了2008年至2021年在我们中心接受心脏瓣膜手术和冠状动脉造影的患者。结果:本研究共纳入7932例患者,其中1332例(16.8%)患有CAD。研究队列的平均年龄为60.5±7.9岁,男性4206例(53.0%)。主动脉疾病为21.4%,二尖瓣疾病为16.2%,孤立三尖瓣疾病为11.8%,主动脉和二尖瓣合并疾病为13.0%。主动脉瓣狭窄患者比反流患者年龄更大(63.6±7.4岁比59.5±8.2岁,P < 0.001),冠心病风险也更高(28.0%比19.2%,P < 0.001)。二尖瓣返流和狭窄患者的年龄差异很小(60.6±8.2岁vs 59.5±6.7岁,P = 0.002),但返流患者的冠心病风险是其两倍(20.2% vs 10.5%, P < 0.001)。当不考虑瓣膜损害类型时,非风湿病病因、高龄、男性、高血压和糖尿病是CAD的独立预测因素。结论:在瓣膜手术患者中,冠心病的患病率受常规危险因素的影响。重要的是,CAD还与瓣膜疾病的类型和病因有关。
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引用次数: 1
Single-Center Retrospective Analysis of Acute Type A Aortic Dissection Outcome and Reoperation Focusing on Extended Versus Limited Initial Repair. 急性A型主动脉夹层结局和再手术的单中心回顾性分析,重点是延长与有限的初始修复。
IF 0.6 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-03-03 DOI: 10.1532/hsf.5345
Mohamed Elbayomi, Michael Weyand, Presheet Pathare, Ehab Nooh, Frank Harig

Background: The optimal management strategy for acute aortic type A dissection remains controversial. Whether a limited primary (index) repair would increase the need for late aortic reintervention is still an open debate.

Methods: A total of 393 consecutive adult patients with acute type A aortic dissection who underwent cardiac surgery were analyzed. Our research hypothesis was whether limited aortic index repair (i.e., isolated aorta ascending replacement without an open distal anastomosis with and without a concomitant aortic valve replacement, including hemiarch replacement procedure) is associated with a higher incidence of late aortic reoperation compared with extended repair (i.e., any other surgical procedure that goes beyond that limited approach).

Results: Type of the initial repair had no statically significant relationship with in-hospital mortality with a P-value of 0.12, however in multivariable analysis, cross-clamp time had a statistically significant relation with mortality (P = 0.4). From the patients who survived until discharge (N = 311), 40 patients needed a reoperation on the aorta; the mean interval until reoperation was 4.5 years. The relationship between the type of the initial repair and the need for reoperation didn't reach a statically significant value (P = 0.9). In-hospitable mortality after the second operation was 10% (N = 4).

Conclusion: We reached two conclusions. 1) An extended prophylactic repair in the initial operation of an acute type A aortic dissection might not lead to a lower incidence of reoperations on the aorta and could increase in-hospital mortality by increasing cross-clamp time, and 2) Reoperation on the aorta could be done safely with acceptable mortality outcomes.

背景:急性A型主动脉夹层的最佳治疗策略仍存在争议。有限的初级(指数)修复是否会增加晚期主动脉再介入治疗的需要仍然是一个公开的争论。方法:对393例连续行心脏手术的成人急性A型主动脉夹层患者进行分析。我们的研究假设是,与扩展修复(即任何其他超出该有限方法的外科手术)相比,有限主动脉指数修复(即,不进行开放远端吻合的孤立主动脉上升置换术,并伴有或不伴有主动脉瓣置换术,包括血腔置换术)是否与晚期主动脉再手术的更高发生率相关。结果:初始修复类型与住院死亡率无统计学意义(P值为0.12),但在多变量分析中,交叉夹持时间与死亡率有统计学意义(P = 0.4)。在存活至出院的患者中(N = 311),有40例患者需要再次进行主动脉手术;再手术的平均时间间隔为4.5年。初次修复的类型与再次手术的需要之间的关系没有达到统计学意义(P = 0.9)。第二次手术后的不适宜居住死亡率为10% (N = 4)。结论:我们得出两个结论。1)急性A型主动脉夹层初次手术延长预防性修复期可能不会降低主动脉再次手术的发生率,反而会增加交叉夹持时间,增加住院死亡率;2)主动脉再次手术可以安全进行,死亡率可接受。
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引用次数: 0
Adult Bone Marrow-Derived Mesenchymal Stem Cells Seeded on Tissue-Engineered Cardiac Patch Contribute to Myocardial Scar Remodeling and Enhance Revascularization in a Rabbit Model of Chronic Myocardial Infarction. 成体骨髓间充质干细胞移植于组织工程心脏贴片有助于兔慢性心肌梗死模型的心肌瘢痕重塑和增强血运重建
IF 0.6 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-03-03 DOI: 10.1532/hsf.5067
Jue Zhang, Mingjiang Wu, Xiaoqiang Zhang, Mingli Yang, Tingwang Xiong, Wei Zhi

Background: Although the transplantation of tissue-engineered cardiac patches with adult bone marrow-derived mesenchymal stem cells (MSCs) can enhance cardiac function after acute or chronic myocardial infarction (MI), the recovery mechanism remains controversial. This experiment aimed to investigate the outcome measurements of MSCs within a tissue-engineered cardiac patch in a rabbit chronic MI model.

Methods: This experiment was divided into four groups: left anterior descending artery (LAD) sham-operation group (N = 7), sham-transplantation (control, N = 7), non-seeded patch group (N = 7), and MSCs-seeded patch group (N = 6). PKH26 and 5-Bromo-2'-deoxyuridine (BrdU) labeled MSCs-seeded or non-seeded patches were transplanted onto chronically infarct rabbit hearts. Cardiac function was evaluated by cardiac hemodynamics. H&E staining was performed to count the number of vessels in the infarcted area. Masson staining was used to observe cardiac fiber formation and to measure scar thickness.

Results: Four weeks after transplantation, a remarkable improvement in cardiac functionality could be distinctly observed, which was most significant in the MSCs-seeded patch group. Moreover, labeled cells were detected in the myocardial scar, with most of them differentiated into myofibroblasts, some into smooth muscle cells, and only a few into cardiomyocytes in the MSCs-seeded patch group. We also observed significant revascularization in the infarct area implanted in either MSCs-seeded or non-seeded patches. In addition, there were significantly greater numbers of microvessels in the MSCs-seeded patch group than in the non-seeded patch group.

背景:虽然组织工程心脏补片移植成人骨髓间充质干细胞(MSCs)可以增强急性或慢性心肌梗死(MI)后的心功能,但其恢复机制仍存在争议。本实验旨在研究兔慢性心肌梗死模型中组织工程心脏补片内MSCs的结果测量。方法:将实验分为4组:左前降支(LAD)假手术组(N = 7)、假移植组(对照组,N = 7)、无籽贴片组(N = 7)、mscs补片组(N = 6),将PKH26和5-溴-2′-脱氧尿苷(BrdU)标记的mscs补片或无籽贴片移植到慢性梗死家兔心脏上。通过心脏血流动力学评价心功能。H&E染色计数梗死区血管数量。马松染色法观察心肌纤维形成,测量瘢痕厚度。结果:移植后4周,心脏功能明显改善,其中以mscs贴片组改善最为显著。此外,在心肌瘢痕中检测到标记细胞,在mscs种子贴片组,大部分细胞分化为肌成纤维细胞,部分分化为平滑肌细胞,只有少数细胞分化为心肌细胞。我们还观察到植入mscs或非mscs贴片的梗死区域有明显的血运重建。此外,mscs植入贴片组的微血管数量明显多于未植入贴片组。
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引用次数: 0
Sternal Reconstruction Using 3D-Printed Titanium Custom-Made Prosthesis for Sternal Dehiscence After Cardiac Surgery. 心脏手术后胸骨裂的3d打印钛定制假体胸骨重建。
IF 0.6 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-03-03 DOI: 10.1532/hsf.5151
Urška Intihar, Jernej Železnik, Tomaž Brajlih, Igor Drstvenšek, Radovan Hudak, Miha Antonič

Sternal dehiscence is an important complication that increases mortality and morbidity in cardiac surgery. Titanium plates have been used to reconstruct the chest wall for a long time. However, with the rise of 3D printing technology, a more sophisticated method, is making a breakthrough. Custom-made 3D-printed titanium prostheses are increasingly used in chest wall reconstruction because they allow almost perfect fitting to the patient's chest wall and lead to good functional and cosmetic results. This report presents a complex anterior chest wall reconstruction using a custom-made titanium 3D-printed implant in a patient with a sternal dehiscence after coronary artery bypass surgery. At first, reconstruction of the sternum was performed using conventional methods, which failed to give adequate results. Finally, a 3D-printed titanium custom-made prosthesis was used for the first time in our center. On the short- and mid-term follow up, good functional results were achieved. In conclusion, this method is suitable for sternal reconstruction after complications in the healing process of median sternotomy wounds in cardiac surgery, especially where other methods do not provide satisfactory results.

胸骨裂是增加心脏手术死亡率和发病率的重要并发症。钛板用于重建胸壁已经有很长时间了。然而,随着3D打印技术的兴起,一种更复杂的方法正在取得突破。定制的3d打印钛假体越来越多地用于胸壁重建,因为它们几乎可以完美地贴合患者的胸壁,并带来良好的功能和美容效果。本报告介绍了冠状动脉搭桥术后胸骨裂患者使用定制的钛3d打印植入物进行复杂的前胸壁重建。起初,胸骨重建采用传统方法,但效果不佳。最后,我们中心首次使用了3d打印的钛定制假体。中短期随访均取得良好的功能效果。综上所述,该方法适用于心脏手术中胸骨正中切口伤口愈合过程中出现并发症后的胸骨重建,尤其适用于其他方法效果不理想的情况。
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引用次数: 0
Corrected Transposition of Great Arteries with Cor Triatriatum and Atrial Septal Defect-Case Report. 矫正大动脉转位合并心房三房心和房间隔缺损1例报告。
IF 0.6 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-03-03 DOI: 10.1532/hsf.5173
Lingwei Meng, Xiangjin Kong, Kaiming Wei, Xin Lv, Chuanzhen Liu, Weidong Bing

A 37-year-old male patient with corrected transposition of great arteries (ccTGA) with cor triatriatum sinister (CTS), left superior vena cava, and atrial septal defects is reported in our case. None of these impacted the patient's growth or development, nor daily work until age 33. Later, the patient developed symptoms of obvious impaired heart function, which improved after medical treatment. However, the symptoms reappeared and gradually worsened two years later, and we decided to treat it with surgery. In this case, we selected tricuspid mechanical valve replacement, cor triatriatum correction, and atrial septal defect repair. During the follow-up of five years, the patient had no obvious symptoms, ECG did not change significantly from five years ago, and the cardiac color Doppler ultrasound showed RVEF 0.51.

我们报告了一位37岁男性大动脉矫正转位(ccTGA)合并心房三房心(CTS),左上腔静脉和房间隔缺损的病例。这些都不会影响患者的生长发育,也不会影响患者在33岁之前的日常工作。后来患者出现明显的心功能受损症状,经治疗后病情好转。然而,两年后症状再次出现并逐渐恶化,我们决定用手术治疗。在这个病例中,我们选择了三尖瓣机械瓣膜置换术、心房矫正术和房间隔缺损修复术。随访5年,患者无明显症状,心电图与5年前无明显变化,心脏彩超RVEF 0.51。
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引用次数: 0
Minimally Invasive Direct Coronary Artery Bypass Versus Percutaneous Coronary Intervention for Isolated Left Anterior Descending Artery Stenosis: An Updated Meta-Analysis. 微创直接冠状动脉搭桥与经皮冠状动脉介入治疗孤立性左前降支狭窄:最新荟萃分析。
IF 0.6 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-02-28 DOI: 10.1532/hsf.5211
Shijie Zhang, Shanghao Chen, Kun Yang, Yi Li, Yan Yun, Xiangxi Zhang, Xing Qi, Xiaoming Zhou, Haizhou Zhang, Chengwei Zou, Xiaochun Ma

Background: The optimal revascularization strategy for isolated left anterior descending (LAD) coronary artery lesion between minimally invasive direct coronary artery bypass (MIDCAB) and percutaneous coronary intervention (PCI) remains controversial. This updated meta-analysis aims to compare the long- and short-term outcomes of MIDCAB versus PCI for patients with isolated LAD coronary artery lesions.

Methods: The Pubmed, Web of Science, and Cochrane databases were searched for retrieving potential publications from 2002 to 2022. The primary outcome was long-term survival. Secondary outcomes were long-term target vessel revascularization (TVR), long-term major adverse cardiovascular events (MACEs), and short-term outcomes, including postoperative mortality, myocardial infarction (MI), TVR, and MACEs of any cause in-hospital or 30 days after the revascularization.

Results: Six randomized controlled trials (RCTs) and eight observational studies were included in this updated meta-analysis. In total, 1757 patients underwent MIDCAB and 15245 patients underwent PCI. No statistically significant difference was found between the two groups in the rates of long-term survival. MIDCAB had a lower long-term MACE rate compared with PCI. Besides, PCI resulted in an augmented risk of TVR. Postoperative mortality, MI, TVR, and MACEs were similar between the two groups.

Conclusions: The updated meta-analysis presents the evidence that MIDCAB has a reduced risk of long-term TVR and MACEs, with no benefit in terms of long-term mortality and short-term results, in comparison with PCI. Large multicenter RCTs, including patients treated with newer techniques, are warranted in the future.

背景:在微创直接冠状动脉搭桥术(MIDCAB)和经皮冠状动脉介入治疗(PCI)之间,孤立的左前降支(LAD)冠状动脉病变的最佳血运重建策略仍存在争议。这项最新的荟萃分析旨在比较MIDCAB与PCI对孤立LAD冠状动脉病变患者的长期和短期结果。方法:检索Pubmed、Web of Science和Cochrane数据库,检索2002 - 2022年的潜在出版物。主要终点是长期生存。次要结局是长期靶血管重建术(TVR)、长期主要不良心血管事件(mace)和短期结局,包括术后死亡率、心肌梗死(MI)、TVR和院内或血运重建术后30天内任何原因的mace。结果:6项随机对照试验(rct)和8项观察性研究纳入了这一更新的荟萃分析。共有1757例患者接受了MIDCAB, 15245例患者接受了PCI。两组患者的长期生存率无统计学差异。与PCI相比,MIDCAB的长期MACE率较低。此外,PCI增加了TVR的风险。两组术后死亡率、心肌梗死、TVR和mace相似。结论:最新的荟萃分析显示,与PCI相比,MIDCAB具有降低长期TVR和mace风险的证据,但在长期死亡率和短期结果方面没有益处。大型多中心随机对照试验,包括采用新技术治疗的患者,将在未来得到保证。
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引用次数: 0
Compression of the Pulmonary Artery and Coronary Artery Caused by Pulmonary Epithelioid Hemangioendothelioma: A Case Report. 肺上皮样血管内皮瘤致肺动脉、冠状动脉压迫1例。
IF 0.6 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-02-28 DOI: 10.1532/hsf.5191
Haihong Zhang, Qin Luo, Nan Xie, Liqun Zou
A 63-year-old woman with a five-month history of pulmonary epithelioid hemangioendothelioma (PEH) presented to the emergency department, due to worsening dyspnea and chest pain. The electrocardiography showed a pattern of ST-segment elevation in leads I, AVL, and poor R-wave progression consistent with anterolateral ischemia. Emergent coronary angiography revealed severe stenosis of the left main coronary artery. Then, contrast-enhanced computed tomography scan indicated the right pulmonary artery and left main coronary artery narrowing by compression of metastasized PEH. Finally, the patient died of deteriorated multi-organ failure.
一名63岁女性,有5个月的肺上皮样血管内皮瘤(PEH)病史,因呼吸困难和胸痛加重而就诊于急诊室。心电图显示I型导联st段抬高,AVL和较差的r波进展与前外侧缺血一致。急诊冠状动脉造影显示左冠状动脉主干严重狭窄。然后,增强计算机断层扫描显示右肺动脉和左冠状动脉主动脉狭窄,压迫转移性PEH。最后,患者死于严重的多器官衰竭。
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引用次数: 1
Intraoperative Type B Aortic Dissection during Total Arch Replacement. 全弓置换术中B型主动脉夹层。
IF 0.6 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-02-28 DOI: 10.1532/hsf.5179
Yojiro Machii, Naohiro Shimada, Fumihiro Kitashima, Masashi Tanaka

Background: Intraoperative aortic dissection is an extremely serious complication that should be prevented whenever possible. When it does occur, it requires urgent clinical management.

Case presentation: We report the case of a 78-year-old man with Marfan syndrome who developed an intraoperative complicated type B aortic dissection with a distal anastomosis entry site during total arch replacement for a chronic dissection.

Conclusion: Performing immediate thoracic endovascular aortic repair, we were able to improve malperfusion to the lower extremities occurred during total arch replacement.

背景:术中主动脉夹层是一种极其严重的并发症,应尽可能预防。当它确实发生时,需要紧急的临床管理。病例介绍:我们报告一例78岁的马凡氏综合征患者,在慢性夹层全弓置换术中并发B型主动脉夹层及远端吻合口入口。结论:立即进行胸椎血管内主动脉修复,可以改善全弓置换术中下肢的灌注不良。
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引用次数: 0
Association of Critical Value With 28-Day Mortality After Cardiac Surgery. 心脏手术后临界值与28天死亡率的关系。
IF 0.6 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-02-28 DOI: 10.1532/hsf.5215
Huan Xu, Yin-Ying Xue, Xiao Shen, Liang Hong, Cui Zhang

Objective: The emergence of critical values gives a warning to the medical safety of hospitalized patients, especially Cardiosurgery Intensive Care Unit (CSICU) patients. The aim of this study was to investigate the association between early postoperative critical values and the prognosis of patients after cardiac surgery.

Methods: Clinical data of the patients were obtained from the Cardiac Critical Care Clinical Database of the Cardiovascular Intensive Care Unit of Nanjing First Hospital. A total of 1,598 consecutive patients undergoing cardiac surgery were enrolled in this retrospective cohort study, during the period from July 2019 to December 2020. According to whether critical value occurred within 7 days after cardiac surgery, patients were divided into two groups: the critical value group and control group. COX regression and survival analysis were performed to analyze the clinical data of the two groups. The area under the receiver operating characteristic curve (ROC) was used to assess the critical value's predictive value and determine the optimal cutoff value.

Results: With patients in the critical value group, the 28-day mortality after cardiac surgery was 21.98%, significantly higher than that of the control group (P < 0.05). Logistic regression analysis revealed the APACHE II score (Adjusted HR-1.11, 95% CI-1.043-1.185) and critical value group (Adjusted HR-13.57, 95% CI-6.714-27.435 ) were independent predictors of 28-day mortality after cardiac surgery. The ROC curve showed that the critical value case model (AUC = 0.748 ± 0.052, P < 0.05) could effectively predict the 28-day mortality, and the optimum cutoff was 1 case (sensitivity 52.63%, specificity 95.70%).

Conclusions: One or more reported cases of critical values in the early postoperative period could be an independent risk factor for 28-day mortality in patients undergoing cardiac surgery. The predictive model based on critical value might be effective in clinical therapy and risk stratification.

目的:临界值的出现对住院患者特别是心外科重症监护病房(CSICU)患者的医疗安全提出警示。本研究的目的是探讨心脏术后早期临界值与患者预后之间的关系。方法:患者临床资料来源于南京市第一医院心血管重症监护室心脏危重症临床数据库。在2019年7月至2020年12月期间,共有1598名连续接受心脏手术的患者入组了这项回顾性队列研究。根据心脏手术后7天内是否出现临界值,将患者分为临界值组和对照组。采用COX回归和生存分析对两组患者的临床资料进行分析。采用受试者工作特征曲线(ROC)下面积评估临界值的预测值,确定最佳截止值。结果:临界值组患者心脏术后28天死亡率为21.98%,显著高于对照组(P < 0.05)。Logistic回归分析显示,APACHE II评分(Adjusted HR-1.11, 95% CI-1.043-1.185)和临界值组(Adjusted HR-13.57, 95% CI-6.714-27.435)是心脏手术后28天死亡率的独立预测因子。ROC曲线显示,临界值病例模型(AUC = 0.748±0.052,P < 0.05)能有效预测28天死亡率,最佳临界值为1例(敏感性52.63%,特异性95.70%)。结论:术后早期报告的一个或多个临界值病例可能是心脏手术患者28天死亡率的独立危险因素。基于临界值的预测模型可能在临床治疗和风险分层中有效。
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引用次数: 0
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Heart Surgery Forum
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