Logeais Y, Leguerrier A, Rioux C, Corbineau H, Langanay T, Verhoye J P, Laurent M, de Place C, Pony J C
Clinique Chirurgicale Cardiovasculaire et Thoracique, Hôpital Pontchaillou, CHU de Rennes, 2 rue Henri Le Guilloux-35033 Rennes.
Bull Acad Natl Med. 2001;185(1):163-74; discussion 174-5.
Aortic stenosis (AS) is the most common lesion currently encountered among valvular heart disease, particularly in elderly people. Severe functional impairment and risk of sudden death explain that surgical treatment is largely accepted. We report a retrospective analysis of institutional experience with aortic valve replacement (AVR) for AS from 1971-1997 in 4,129 patients. Age ranged from 13 to 91 years (mean 68 +/- 10) and degenerative disease was largely predominant (86%). For AVR, mechanical prostheses were used in 2,054 patients (50.2%) and bioprostheses in 2,075 (48.8%) in elderly group. Coronary artery revascularization was associated in 670 patients (16%). Operative mortality was 7% (303 pts) and main cause was left ventricular failure (52%). Late results were studied with a maximum follow-up of 26 years. Total follow-up represents 21,533 pt-years. Late death occurred in 1,108 patients between 1 month and 24 years after operation (mean 6.6 years). Reoperation was necessary in 136 cases. Actuarial survival--including operative mortality--was 77% and 56% at 5 and 10 years. A large functional improvement was observed in the vast majority of patients, 73% being I or II subgroups of the NYHA classification. Incremental risk factors for death (immediate as well as late) were older age, preoperative functional status, emergency, presence of cardiac failure, coronary artery lesions and associated morbidity. The choice of valvular prosthesis remains controversial, but the results show that AVR is the procedure of choice for the vast majority of patients wtih significant aortic valve disease.
主动脉瓣狭窄（AS）是目前在心脏瓣膜病中最常见的病变，尤其是在老年人中。严重的功能损害和猝死风险表明手术治疗已被广泛接受。我们报告了对1971年至1997年期间4129例因AS行主动脉瓣置换术（AVR）的机构经验的回顾性分析。年龄范围为13至91岁（平均68±10岁），退行性疾病占主导地位（86%）。在老年组中，2054例患者（50.2%）使用了机械瓣膜，2075例患者（48.8%）使用了生物瓣膜。670例患者（16%）同时进行了冠状动脉血运重建。手术死亡率为7%（303例），主要原因是左心室衰竭（52%）。对晚期结果进行了研究，最长随访时间为26年。总随访时间为21533患者年。术后1个月至24年（平均6.6年）有1108例患者发生晚期死亡。136例患者需要再次手术。包括手术死亡率在内的精算生存率在5年和10年时分别为77%和56%。绝大多数患者有明显的功能改善，73%属于纽约心脏协会（NYHA）分级的I或II级亚组。死亡的增加危险因素（即刻和晚期）包括年龄较大、术前功能状态、急诊情况、心力衰竭的存在、冠状动脉病变和相关并发症。瓣膜假体的选择仍存在争议，但结果表明AVR是绝大多数有严重主动脉瓣疾病患者的首选手术方式。
