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circulation2010-06-29

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(Circulation. 2010;121:2711-2717.)
© 2010 American Heart Association, Inc.

abstract 1 of 6

Arrhythmia/Electrophysiology
Effect of Nonuniform Muscle Contraction on Sustainability and Frequency of Triggered Arrhythmias in Rat Cardiac Muscle
Masahito Miura, MD, PhD*; Taichi Nishio, MSc*; Taiki Hattori, BA; Naomi Murai, BA; Bruno D. Stuyvers, PhD; Chiyohiko Shindoh, MD, PhD; Penelope A. Boyden, PhD
From the Department of Clinical Physiology, Health Science, Tohoku University Graduate School of Medicine, Sendai, Japan (M.M., T.N., T.H., N.M., C.S.); Faculty of Medicine, Biomedical Sciences, Memorial University, St John’s, Newfoundland, Canada (B.D.S.); and Department of Pharmacology, Columbia College of Physicians and Surgeons, New York, NY (P.A.B.).
Received September 23, 2009; accepted April 30, 2010.
Background— Arrhythmias are benign or lethal, depending on their sustainability and frequency. To determine why lethal arrhythmias are prone to occur in diseased hearts, usually characterized by nonuniform muscle contraction, we investigated the effect of nonuniformity on sustainability and frequency of triggered arrhythmias.
Methods and Results— Force, membrane potential, and intracellular Ca2+ concentration ([Ca2+]i) were measured in 51 rat ventricular trabeculae. Nonuniform contraction was produced by exposing a restricted region of muscle to a jet of 20 mmol/L 2,3-butanedione monoxime (BDM) or 20 µmol/L blebbistatin. Sustained arrhythmias (>10 seconds) could be induced by stimulus trains for 7.5 seconds only with the BDM or blebbistatin jet (100 nmol/L isoproterenol, 1.0 mmol/L [Ca2+]o, 24°C). During sustained arrhythmias, Ca2+ surges preceded synchronous increases in [Ca2+]i, whereas the stoppage of the BDM jet made the Ca2+ surges unclear and arrested sustained arrhythmias (n=6). With 200 nmol/L isoproterenol, 2.5 mmol/L [Ca2+]o, and the BDM jet, lengthening or shortening of the muscle during sustained arrhythmias accelerated or decelerated their cycle in both the absence (n=10) and presence (n=10) of 100 µmol/L streptomycin, a stretch-activated channel blocker, respectively. The maximum rate of force relaxation correlated inversely with the change in cycle lengths (n=14; P<0.01). Sustained arrhythmias with the BDM jet were significantly accelerated by 30 µmol/L SCH00013, a Ca2+ sensitizer of myofilaments (n=10).
Conclusion— These results suggest that nonuniformity of muscle contraction is an important determinant of the sustainability and frequency of triggered arrhythmias caused by the surge of Ca2+ dissociated from myofilaments in cardiac muscle.

abstract 2 of 6

Cardiovascular Surgery
Outcomes of Endovascular Repair of Ruptured Descending Thoracic Aortic Aneurysms
Frederik H.W. Jonker, MD; Hence J.M. Verhagen, MD, PhD; Peter H. Lin, MD; Robin H. Heijmen, MD, PhD; Santi Trimarchi, MD; W. Anthony Lee, MD; Frans L. Moll, MD, PhD; Husam Athamneh, MD; Bart E. Muhs, MD, PhD
From the Section of Vascular Surgery, Cardiothoracic Surgery and Interventional Radiology, Yale University School of Medicine, New Haven, and VA Connecticut Healthcare System, West Haven, Conn (F.H.W.J., B.E.M.); Erasmus University Medical Center (H.J.M.V.), Rotterdam; St. Antonius Hospital (R.H.H.), Nieuwegein; University Medical Center Utrecht (F.L.M.), Utrecht, the Netherlands; Baylor College of Medicine (P.H.L., H.A.), Houston, Tex; Policlinico San Donato IRCCS, Cardiovascular Center "E. Malan," University of Milano (S.T.), Milan, Italy; and University of Florida College of Medicine (A.L.), Gainesville, Fla.
Correspondence to Dr Bart E. Muhs, Co-Director, Endovascular Program, Assistant Professor of Surgery and Radiology, Yale University School of Medicine, 330 Cedar St, BB-204, New Haven, CT 06510. E-mail bart.muhs@yale.edu
Received September 15, 2009; accepted April 19, 2010.
Background— Thoracic endovascular aortic repair offers a less invasive approach for the treatment of ruptured descending thoracic aortic aneurysms (rDTAA). Due to the low incidence of this life-threatening condition, little is known about the outcomes of endovascular repair of rDTAA and the factors that affect these outcomes.
Methods and Results— We retrospectively investigated the outcomes of 87 patients who underwent thoracic endovascular aortic repair for rDTAA at 7 referral centers between 2002 and 2009. The mean age was 69.8±12 years and 69.0% of the patients were men. Hypovolemic shock was present in 21.8% of patients, and 40.2% were hemodynamically unstable. The 30-day mortality rate was 18.4%, and hypovolemic shock (odds ratio 4.75; 95% confidence interval, 1.37 to 16.5; P=0.014) and hemothorax at admission (odds ratio 6.65; 95% confidence interval, 1.64 to 27.1; P=0.008) were associated with increased 30-day mortality after adjusting for age. Stroke and paraplegia occurred each in 8.0%, and endoleak was diagnosed in 18.4% of patients within the first 30 days after thoracic endovascular aortic repair. Four additional patients died as a result of procedure-related complications during a median follow-up of 13 months; the estimated aneurysm-related mortality at 4 years was 25.4%.
Conclusion— Endovascular repair of rDTAA is associated with encouraging results. The endovascular approach was associated with considerable rates of neurological complications and procedure-related complications such as endoleak.

abstract 3 of 6

Heart Failure
Impact of Collateral Flow to the Occluded Infarct-Related Artery on Clinical Outcomes in Patients With Recent Myocardial Infarction: A Report From the Randomized Occluded Artery Trial
Ph. Gabriel Steg, MD; Arthur Kerner, MD; G. B. John Mancini, MD; Harmony R. Reynolds, MD; Antonio C. Carvalho, MD; Viliam Fridrich, MD, PhD; Harvey D. White, MD; Sandra A. Forman, MA; Gervasio A. Lamas, MD; Judith S. Hochman, MD; Christopher E. Buller, MD, for the OAT Investigators
From L'Institut National de la Santé et de la Recherche Médicale U-698, Université Paris 7 and Assistance Publique Hôpitaux de Paris (P.G.S.), Paris, France; Rambam Medical Center (A.K.), Haifa, Israel; Vancouver General Hospital (J.M., C.E.B.), Vancouver, British Columbia, Canada; Hospital São Paulo (A.C.C.), Moema–São Paulo, Brazil; Maryland Medical Research Institute (S.A.F.), Baltimore, Md; Slovak Institute of Cardiovascular Diseases (V.F.), Bratislava, Slovakia; New York University School of Medicine (H.R.R., J.S.H.), New York, NY; Columbia University Division of Cardiology, Mount Sinai Medical Center (G.A.L.), Miami Beach, Fla; Green Lane Cardiovascular Service (H.D.W.), Auckland, New Zealand.
Correspondence to Ph. Gabriel Steg, INSERM U-698 and Département de Cardiologie, Centre Hospitalier Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris, 46 rue Henri Huchard, 75877 Paris Cedex 18, France. E-mail gabriel.steg@bch.ap-hop-paris.fr
Received December 25, 2009; accepted April 20, 2010.
Background— Collateral flow to the infarct artery territory after acute myocardial infarction may be associated with improved clinical outcomes and may also impact the benefit of subsequent recanalization of an occluded infarct-related artery.
Methods and Results— To understand the association between baseline collateral flow to the infarct territory on clinical outcomes and its interaction with percutaneous coronary intervention of an occluded infarct artery, long-term outcomes in 2173 patients with total occlusion of the infarct artery 3 to 28 days after myocardial infarction from the randomized Occluded Artery Trial were analyzed according to angiographic collaterals documented at study entry. There were important differences in baseline clinical and angiographic characteristics as a function of collateral grade, with generally lower-risk characteristics associated with higher collateral grade. Higher collateral grade was associated with lower rates of death (P=0.009), class III and IV heart failure (P<0.0001) or either (P=0.0002) but had no association with the risk of reinfarction. However, by multivariate analysis, collateral flow was neither an independent predictor of death nor of the primary end point of the trial (composite of death, reinfarction, or class IV heart failure). There was no interaction between angiographic collateral grade and the results of randomized treatment assignment (percutaneous coronary intervention or medical therapy alone) on clinical outcomes.
Conclusions— In recent myocardial infarction, angiographic collaterals to the occluded infarct artery are correlates but not independent predictors of major clinical outcomes. Late recanalization of the infarct artery in addition to medical therapy shows no benefit compared with medical therapy alone, regardless of the presence or absence of collaterals. Therefore, revascularization decisions in patients with recent myocardial infarction should not be based on the presence or grade of angiographic collaterals.

abstract 4 of 6

Valvular Heart Disease
Survival of Kidney Transplantation Patients in the United States After Cardiac Valve Replacement
Alok Sharma, MD; David T. Gilbertson, PhD; Charles A. Herzog, MD
From the Department of Internal Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis (A.S., C.A.H.), and Cardiovascular Special Studies Center, United States Renal Data System, Minneapolis Medical Research Foundation, Minneapolis, Minn (D.T.G., C.A.H.).
Correspondence to Charles A. Herzog, MD, Cardiovascular Special Studies Center, United States Renal Data System, Minneapolis Medical Research Foundation, 914 S 8th St, Suite S-406, Minneapolis, MN 55404. E-mail cherzog@usrds.org
Received September 25, 2009; accepted April 30, 2010.
Background— Few published studies address the survival of kidney transplantation patients after valve surgery, and none address relative outcomes related to tissue versus nontissue prosthesis. This study aimed to assess survival of US kidney transplantation patients after cardiac valve replacement and to compare associations of valve selection.
Methods and Results— Of 1 698 706 patients in the US Renal Data System database, we identified 1335 kidney transplantation patients hospitalized in 1991 to 2004 for cardiac valve replacement. Survival was estimated by the Kaplan-Meier method; independent predictors of death were examined in a comorbidity-adjusted (by Charlson and propensity score) Cox model. Of the cohort, 17% were 0 to 44 years of age, 50% were 45 to 64 years of age, 28% were 65 to 74 years of age, and 5% were 75 years of age; 78% were white; 63% were men; and 20% had kidney failure caused by diabetes mellitus. Of 369 patients (28%) who received tissue valves, 75% had aortic valve replacement, 20% had mitral valve replacement, and 5% had both. Use of tissue valves increased from 13% in 1991 to 1995 to 38% in 2000 to 2004. Age, diabetes mellitus, and combined aortic and mitral valve replacement were the strongest predictors of all-cause mortality. In-hospital mortality was 14.0% overall, 11.4% for tissue-valve patients, and 15.0% for nontissue-valve patients (P=0.09). Two-year survival estimates were 61.5% for tissue-valve and 59.5% for nontissue-valve patients (P=0.30). The adjusted hazard ratio of death for tissue- versus nontissue-valve patients was 0.83 (95% confidence interval, 0.70 to 0.99).
Conclusions— Renal transplantation patients requiring valve replacement have high mortality rates ( 20%/y). These data suggest minimally reduced mortality risk for patients receiving tissue versus nontissue valves.

abstract 5 of 6

Vascular Medicine
Long-Term Evaluation of the Risk of Recurrence After Cerebral Sinus-Venous Thrombosis
Ida Martinelli, MD, PhD; Paolo Bucciarelli, MD; Serena M. Passamonti, MD; Tullia Battaglioli, MD; Emanuele Previtali, MD; Pier Mannuccio Mannucci, MD
From the A. Bianchi Bonomi Hemophilia and Thrombosis Center, Department of Internal Medicine and Medical Specialties, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
Correspondence to Ida Martinelli, MD, PhD, Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via Pace, 9, 20122 Milan, Italy. E-mail martin@policlinico.mi.it
Received November 28, 2009; accepted April 29, 2010.
Background— The clinical course of cerebral sinus-venous thrombosis (CSVT) is largely unknown because prospective studies with a long follow-up and with the goal to assess thrombosis recurrence rate and predisposing factors for recurrence are lacking.
Methods and Results— One hundred forty-five patients with a first CSVT were followed up for a median of 6 years after discontinuation of anticoagulant treatment. End points were recurrent CSVT or other clinical manifestations of venous thromboembolism. CSVT recurred in 5 patients (3%) and other manifestations of venous thromboembolism (deep vein thrombosis of the lower limbs or pulmonary embolism) were seen in 10 additional patients (7%), for a recurrence rate of 2.03 per 100 person-years (95% confidence interval, 1.16 to 3.14) for all manifestations of venous thromboembolism and 0.53 per 100 person-years (95% confidence interval, 0.16 to 1.10) for CSVT. Nearly half of the recurrences occurred within the first year after discontinuation of anticoagulant therapy. Risk factors for recurrent venous thrombosis were male sex (adjusted hazard ratio, 9.66; 95% confidence interval, 2.86 to 32.7) and, for thromboses other than CSVT, severe thrombophilia resulting from antithrombin, protein C, protein S deficiency, anti-phospholipid antibodies, or combined abnormalities (adjusted hazard ratio, 4.71; 95% confidence interval, 1.34 to 16.5).
Conclusions— The risk of recurrent CSVT is low and is higher in the first year after discontinuation of anticoagulant treatment and among men. Mild thrombophilia abnormalities are not associated with recurrent CSVT, but severe thrombophilia entails an increased risk of deep vein thrombosis of the lower limbs or pulmonary embolism.

abstract 6 of 6

Vascular Medicine
Formation of Plexiform Lesions in Experimental Severe Pulmonary Arterial Hypertension
Kohtaro Abe, MD, PhD; Michie Toba, MD; Abdallah Alzoubi, MD; Masako Ito, PhD; Karen A. Fagan, MD; Carlyne D. Cool, MD; Norbert F. Voelkel, MD; Ivan F. McMurtry, PhD; Masahiko Oka, MD, PhD
From the Departments of Pharmacology (K.A.F., I.F.M., M.O.), Biochemistry and Molecular Biology (K.A.), and Medicine (K.A., K.A.F., I.F.M., M.O.) and Center for Lung Biology (K.A., M.T., A.A., M.I., K.A.F., I.F.M., M.O.), University of South Alabama, Mobile, Ala; Department of Pathology, University of Colorado, Aurora, Colo (C.D.C.); and Department of Pulmonary Medicine and Critical Care, Virginia Commonwealth University, Richmond, Va (N.F.V.).
Correspondence to Masahiko Oka, MD, PhD, Departments of Medicine and Pharmacology, Center for Lung Biology, University of South Alabama, 3158 MSB Mobile, AL 36688-0002. E-mail moka@usouthal.edu
Received November 30, 2009; accepted April 30, 2010.
Background— The plexiform lesion is the hallmark of severe pulmonary arterial hypertension. However, its genesis and hemodynamic effects are largely unknown because of the limited availability of lung tissue samples from patients with pulmonary arterial hypertension and the lack of appropriate animal models. This study investigated whether rats with severe progressive pulmonary hypertension developed plexiform lesions.
Methods and Results— After a single subcutaneous injection of the vascular endothelial growth factor receptor blocker Sugen 5416, rats were exposed to hypoxia for 3 weeks. They were then returned to normoxia for an additional 10 to 11 weeks. Hemodynamic and histological examinations were performed at 13 to 14 weeks after the Sugen 5416 injection. All rats developed pulmonary hypertension (right ventricular systolic pressure 100 mm Hg) and severe pulmonary arteriopathy, including concentric neointimal and complex plexiform-like lesions. There were 2 patterns of complex lesion formation: a lesion forming within the vessel lumen (stalk-like) and another that projected outside the vessel (aneurysm-like). Immunohistochemical analyses showed that these structures had cellular and molecular features closely resembling human plexiform lesions.
Conclusions— Severe, sustained pulmonary hypertension in a very late stage of the Sugen 5416/hypoxia/normoxia-exposed rat is accompanied by the formation of lesions that are indistinguishable from the pulmonary arteriopathy of human pulmonary arterial hypertension. This unique model provides a new and rigorous approach for investigating the genesis, hemodynamic effects, and reversibility of plexiform and other occlusive lesions in pulmonary arterial hypertension.

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认领第二篇，第四篇。

2010-06-29 06:12

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• 中级证为什么不能全国通用，那考了还有什么用

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摘要2

Cardiovascular Surgery
心血管外科

Outcomes of Endovascular Repair of Ruptured Descending Thoracic Aortic Aneurysms
破裂的胸降主动脉瘤血管内修补结局

Background— Thoracic endovascular aortic repair offers a less invasive approach for the treatment of ruptured descending thoracic aortic aneurysms (rDTAA). Due to the low incidence of this life-threatening condition, little is known about the outcomes of endovascular repair of rDTAA and the factors that affect these outcomes.
背景-胸主动脉血管内修补为破裂的胸降主动脉瘤(rDTAA)的治疗提供了一种创伤较小的方法。由于这种危及生命的情况发生率低，对rDTAA血管内修补的结局和影响结局的风险因素知之甚少。

Methods and Results— We retrospectively investigated the outcomes of 87 patients who underwent thoracic endovascular aortic repair for rDTAA at 7 referral centers between 2002 and 2009. The mean age was 69.8±12 years and 69.0% of the patients were men. Hypovolemic shock was present in 21.8% of patients, and 40.2% were hemodynamically unstable. The 30-day mortality rate was 18.4%, and hypovolemic shock (odds ratio 4.75; 95% confidence interval, 1.37 to 16.5; P=0.014) and hemothorax at admission (odds ratio 6.65; 95% confidence interval, 1.64 to 27.1; P=0.008) were associated with increased 30-day mortality after adjusting for age. Stroke and paraplegia occurred each in 8.0%, and endoleak was diagnosed in 18.4% of patients within the first 30 days after thoracic endovascular aortic repair. Four additional patients died as a result of procedure-related complications during a median follow-up of 13 months; the estimated aneurysm-related mortality at 4 years was 25.4%.
方法和结果-我们对2002-2009年间7个中心87名行rDTAA血管内修补的患者进行了回顾性调查。平均年龄69.8±12岁，69.0%为男性。有21.8%的患者出现低血容量性休克，40.2%的患者血流动力学不稳定。30天死亡率为18.4%，在校正了年龄因素后，低血容量性休克(优势比 4.75; 95% 置信区间, 1.37 ~16.5; P=0.014)及入院时存在血胸(优势比6.65; 95% 置信区间, 1.64~27.1; P=0.008)和30天死亡率增加有关。脑卒中和截瘫各自的发生率均为8.0%，胸主动脉血管内修补后头30天内血管内渗漏的发生率为18.4%。额外4个病人因操作并发症在中位数为13个月的随访期内死亡，估测的动脉瘤相关的4年死亡率为25.4%。

Conclusion— Endovascular repair of rDTAA is associated with encouraging results. The endovascular approach was associated with considerable rates of neurological complications and procedure-related complications such as endoleak.
结论- rDTAA血管内修补的结果是鼓舞人心的。血管内治疗方法和较高的神经系统并发症以及操作相关并发症如血管内渗漏的发生率有关。

汇总

心血管外科

破裂的胸降主动脉瘤血管内修补结局

背景-胸主动脉血管内修补为破裂的胸降主动脉瘤(rDTAA)的治疗提供了一种创伤较小的方法。由于这种危及生命的情况发生率低，对rDTAA血管内修补的结局和影响结局的风险因素知之甚少。

方法和结果-我们对2002-2009年间7个中心87名行rDTAA血管内修补的患者进行了回顾性调查。平均年龄69.8±12岁，69.0%为男性。有21.8%的患者出现低血容量性休克，40.2%的患者血流动力学不稳定。30天死亡率为18.4%，在校正了年龄因素后，低血容量性休克(优势比 4.75; 95% 置信区间, 1.37 ~16.5; P=0.014)及入院时存在血胸(优势比6.65; 95% 置信区间, 1.64~27.1; P=0.008)和30天死亡率增加有关。脑卒中和截瘫各自的发生率均为8.0%，胸主动脉血管内修补后头30天内血管内渗漏的发生率为18.4%。额外4个病人因操作并发症在中位数为13个月的随访期内死亡，估测的动脉瘤相关的4年死亡率为25.4%。

结论- rDTAA血管内修补的结果是鼓舞人心的。血管内治疗方法和较高的神经系统并发症以及操作相关并发症如血管内渗漏的发生率有关。

2010-06-29 12:16

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• 【规培笔记128】—工作报告偶遇，颅脑MR，您能看出几处异常？据说工作中很罕见！

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摘要4

Valvular Heart Disease
瓣膜性心脏病

Survival of Kidney Transplantation Patients in the United States After Cardiac Valve Replacement
美国心脏瓣膜置换术后肾移植患者的生存率

Background— Few published studies address the survival of kidney transplantation patients after valve surgery, and none address relative outcomes related to tissue versus nontissue prosthesis. This study aimed to assess survival of US kidney transplantation patients after cardiac valve replacement and to compare associations of valve selection.
背景-报道瓣膜术后肾移植患者生存率的研究很少，且没有描述组织瓣膜对比非组织瓣膜假体相关结局的文献。该研究旨在评价美国心脏瓣膜置换术后肾移植患者的生存率，同时比较和瓣膜类型选择的相关性。

Methods and Results— Of 1 698 706 patients in the US Renal Data System database, we identified 1335 kidney transplantation patients hospitalized in 1991 to 2004 for cardiac valve replacement. Survival was estimated by the Kaplan-Meier method; independent predictors of death were examined in a comorbidity-adjusted (by Charlson and propensity score) Cox model. Of the cohort, 17% were 0 to 44 years of age, 50% were 45 to 64 years of age, 28% were 65 to 74 years of age, and 5% were 75 years of age; 78% were white; 63% were men; and 20% had kidney failure caused by diabetes mellitus. Of 369 patients (28%) who received tissue valves, 75% had aortic valve replacement, 20% had mitral valve replacement, and 5% had both. Use of tissue valves increased from 13% in 1991 to 1995 to 38% in 2000 to 2004. Age, diabetes mellitus, and combined aortic and mitral valve replacement were the strongest predictors of all-cause mortality. In-hospital mortality was 14.0% overall, 11.4% for tissue-valve patients, and 15.0% for nontissue-valve patients (P=0.09). Two-year survival estimates were 61.5% for tissue-valve and 59.5% for nontissue-valve patients (P=0.30). The adjusted hazard ratio of death for tissue- versus nontissue-valve patients was 0.83 (95% confidence interval, 0.70 to 0.99).
方法和结果-在美国肾脏数据系统数据库的1698706患者中，我们找出1991-2004年间1335名心脏瓣膜置换术后行肾移植的住院患者。通过Kaplan-Meier方法估测生存率，死亡的独立预测因子通过校正共病的Cox模型(通过Charlson 倾向评分)估测。在该队列中，0-44岁的占17%，45-64岁的占50%，65-74岁的占28%，75岁以上的占5%。白人占78%，男性占63%，20%的患者为糖尿病导致的肾功能衰竭。369名患者（28%）接受了组织瓣，75%为主动脉瓣置换，20%为二尖瓣置换，5%为二尖瓣主动脉瓣双瓣置换。从1991-1995至2000-2004年间组织瓣的使用从13%增加至38%。年龄、糖尿病和二尖瓣主动脉瓣双瓣置换是总死亡率的最强预测因子。住院总死亡率是14.0%，组织瓣患者为11.4%，非瓣膜患者为15.0% (P=0.09)。组织瓣和非组织瓣患者的两年生存率估测值分别为61.5%和59.5%(P=0.30)。组织瓣和非组织瓣患者相比校正后的风险比为0.83 (95%置信区间, 0.70 ~0.99)。

Conclusions— Renal transplantation patients requiring valve replacement have high mortality rates ( 20%/y). These data suggest minimally reduced mortality risk for patients receiving tissue versus nontissue valves.
结论-瓣膜置换术后肾移植患者死亡率高（每年20%）。这些数据表明接受组织瓣的患者较非组织瓣能够将死亡风险降到最小。

汇总

瓣膜性心脏病

美国心脏瓣膜置换术后肾移植患者的生存率

背景-报道瓣膜术后肾移植患者生存率的研究很少，且没有描述组织瓣膜对比非组织瓣膜假体相关结局的文献。该研究旨在评价美国心脏瓣膜置换术后肾移植患者的生存率，同时比较和瓣膜类型选择的相关性。

方法和结果-在美国肾脏数据系统数据库的1698706患者中，我们找出1991-2004年间1335名心脏瓣膜置换术后行肾移植的住院患者。通过Kaplan-Meier方法估测生存率，死亡的独立预测因子通过校正共病的Cox模型(通过Charlson 倾向评分)估测。在该队列中，0-44岁的占17%，45-64岁的占50%，65-74岁的占28%，75岁以上的占5%。白人占78%，男性占63%，20%的患者为糖尿病导致的肾功能衰竭。369名患者（28%）接受了组织瓣，75%为主动脉瓣置换，20%为二尖瓣置换，5%为二尖瓣主动脉瓣双瓣置换。从1991-1995至2000-2004年间组织瓣的使用从13%增加至38%。年龄、糖尿病和二尖瓣主动脉瓣双瓣置换是总死亡率的最强预测因子。住院总死亡率是14.0%，组织瓣患者为11.4%，非瓣膜患者为15.0% (P=0.09)。组织瓣和非组织瓣患者的两年生存率估测值分别为61.5%和59.5%(P=0.30)。组织瓣和非组织瓣患者相比校正后的风险比为0.83 (95%置信区间, 0.70 ~0.99)。

结论-瓣膜置换术后肾移植患者死亡率高（每年20%）。这些数据表明接受组织瓣的患者较非组织瓣能够将死亡风险降到最小。

2010-06-29 12:22

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