[适用于分析主动脉瓣置换术中必要的间隔肌切除术的量表]。

Q4 Medicine Khirurgiya Pub Date : 2024-01-01 DOI:10.17116/hirurgia202412235
M A Fomin, E P Evseev, E V Balakin, Ya A Aidamirov, A A Botashev, V A Ivanov, T G Nikityuk
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引用次数: 0

摘要

目的:探讨重度主动脉瓣狭窄患者行主动脉瓣置换术(AVR)中必要的室间隔肌切除术(SME)的适用量表。材料和方法:回顾性和前瞻性分析纳入2012年至2024年间接受手术治疗的180例重度主动脉瓣狭窄和室间隔肥厚≥1.5 cm的患者。年龄64岁(61岁;67.3)年。男性96例(53.3%),女性84例(46.7%)。心衰NYHA III级98例(54.4%),II级54例(30.0%)。AVR+SME组100例,AVR组80例。两组术前临床及超声心动图特征均无差异。结果:采用Logistic回归确定显著的预测因素。多因素分析提供logistic函数,包括3个预测因子:IVST / PWT、指标左室心肌质量和主动脉环直径。回归模型包含了第一阶段分析得到的显著因子。获得的预后模型具有显著性(p = 83.5),表明SME在主动脉瓣置换术中是可取的。结论:新的预测AVR术后需要SME的量表可改善术后效果。
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[Adapted scale for analysis of necessary septal myectomy in aortic valve replacement].

Objective: To develop the adapted scale for analysis of necessary septal myectomy (SME) in aortic valve replacement (AVR) for severe aortic stenosis.

Material and methods: A retrospective and prospective analysis included 180 patients with severe aortic stenosis and interventricular septal hypertrophy ≥1.5 cm who underwent surgery between 2012 and 2024. Age of patients was 64 (61; 67.3) years. There were 96 (53.3%) men and 84 (46.7%) women. Heart failure NYHA class III was observed in 98 patients (54.4%), class II in 54 (30.0%) patients. The AVR+SME group included 100 patients, and the AVR group included 80 patients. Both groups did not differ in preoperative clinical and echocardiography characteristics.

Results: Logistic regression was performed to identify significant predictors. Multivariate analysis provided logistic function including 3 predictors: IVST / PWT, indexed LV myocardial mass and aortic annulus diameter. Regression model included significant factors obtained at the first stage of analysis. The obtained prognostic model was significant (p<0.01). Sensitivity was 77.0%, specificity - 83.8%. IVST/ PWT and indexed LV myocardial mass increase the probability of concomitant SME, while aortic annulus diameter has inverse relationship. The cut-off point for indexed LV myocardial mass is 167.5 g, for IVST/ PWT - 1.15, for aortic annulus diameter - 23.5 mm. Further analysis was performed by assigning a score to each predictor. The total score in two groups was determined. Thus, total score > 83.5 indicates advisability of SME in aortic valve replacement.

Conclusion: The new scale for predicting the need for SME in AVR will improve postoperative results.

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来源期刊
Khirurgiya
Khirurgiya Medicine-Medicine (all)
CiteScore
0.70
自引率
0.00%
发文量
161
期刊介绍: Хирургия отдельных областей сердце, сосуды легкие пищевод молочная железа желудок и двенадцатиперстная кишка кишечник желчевыводящие пути печень
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