Buchwald A B, Meyer T, Scholz K, Schorn B, Unterberg C
Departments of Cardiology Surgery, University Clinic Göttingen, Germany.
Clin Cardiol. 2001 Mar;24(3):214-8. doi: 10.1002/clc.4960240308.
Because of limited long-term success, aortic balloon valvuloplasty is considered to be a palliative procedure, including patients at excessive risk for standard therapy-aortic valve replacement-that is, those in cardiogenic shock.
The study was undertaken to evaluate the outcome of balloon valvuloplasty for critical aortic stenosis complicated by cardiogenic shock.
Over a 10-year-period, we followed 14 patients (age 74+/-11 years, range 50-91) presenting in cardiogenic shock and critical aortic stenosis, who underwent valvuloplasty, together with 19 patients with critical aortic stenosis requiring urgent major noncardiac surgery.
In patients in shock, calculated aortic valve area could be increased successfully by at least 0.3 cm2, from 0.38+/-0.09 to 0.81+/-0.12 cm2, with an insignificant increase in cardiac index from 1.89+/-0.33 to 2.01+/-0.41 l/min * m2. In-hospital mortality was 71% (10 patients). Two patients underwent valve replacement within 16 days and survived after 1 year, as did two patients refusing surgery. By multivariate logistic regression analysis, only an interval between onset of shock symptoms and valvuloplasty of > 48 h was significantly associated with fatal outcome (p < 0.01). In those patients requiring noncardiac surgery, this was possible after valvuloplasty in 95% who survived 1 year after hospital discharge. One patient in this group died of pulmonary embolism the day after the procedure.
These data support the concept of causal treatment in patients with cardiogenic shock, as well as in the setting of cardiogenic shock and critical aortic stenosis, at the earliest possible convenience.
由于长期成功率有限，主动脉球囊瓣膜成形术被视为一种姑息性手术，适用于标准治疗（主动脉瓣置换术）风险过高的患者，即心源性休克患者。
本研究旨在评估球囊瓣膜成形术治疗合并心源性休克的严重主动脉瓣狭窄的疗效。
在10年期间，我们随访了14例（年龄74±11岁，范围50 - 91岁）出现心源性休克和严重主动脉瓣狭窄并接受瓣膜成形术的患者，以及19例需要紧急进行非心脏大手术的严重主动脉瓣狭窄患者。
休克患者中，计算得出的主动脉瓣面积可成功增加至少0.3平方厘米，从0.38±0.09平方厘米增至0.81±0.12平方厘米，心脏指数从1.89±0.33升/分钟·平方米增至2.01±0.41升/分钟·平方米，但增加不显著。住院死亡率为71%（10例患者）。2例患者在16天内接受了瓣膜置换术，1年后存活，另外2例拒绝手术的患者也存活。通过多因素逻辑回归分析，仅休克症状出现与瓣膜成形术之间的间隔>48小时与致命结局显著相关（p<0.01）。在那些需要进行非心脏手术的患者中，95%在出院后存活1年的患者在瓣膜成形术后能够进行手术。该组中有1例患者在手术后第二天死于肺栓塞。
这些数据支持尽早对心源性休克患者以及合并心源性休克和严重主动脉瓣狭窄的患者进行病因治疗的理念。
