Chaliki Hari P, Mohty Dania, Avierinos Jean-Francois, Scott Christopher G, Schaff Hartzell V, Tajik A Jamil, Enriquez-Sarano Maurice
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minn 55905, USA.
Circulation. 2002 Nov 19;106(21):2687-93. doi: 10.1161/01.cir.0000038498.59829.38.
Left ventricular dysfunction is an indication for aortic valve replacement (AVR) in patients with severe aortic regurgitation (AR). However, the postoperative outcome of patients with severe AR and a markedly low ejection fraction (EF) is not known.
The study group consisted of a total of 450 patients who had AVR for isolated AR between 1980 and 1995. Patients with markedly reduced left ventricular function (EF <35%, LoEF, n=43) were compared with those with moderate reduction in left ventricular function (EF 35% to 50%, MedEF, n=134) and those with normal left ventricular function (EF > or =50%, Nl EF, n=273). The operative mortality rate was higher with LoEF (14%) than with MedEF and Nl EF (6.7% and 3.7%, respectively, P=0.02). At 10 years, 41%+/-9% of LoEF patients had survived compared with 56%+/-5% and 70%+/-3% of MedEF and Nl EF patients, respectively (P<0.0001). Congestive heart failure occurred at 10 years in 25%+/-9% with LoEF compared with 17%+/-4% and 9%+/-2% with MedEF and NL EF, respectively (P<0.003). Postoperative EF improved by 4.9%+/-13.8% in the LoEF group and by 4%+/-11.9% in the MedEF group compared with -2.3%+/-10.9% in the Nl EF group (P<0.002 and P<0.0001, respectively).
Patients with severe AR and markedly low EF incur excess operative mortality rates, postoperative mortality rates, and congestive heart failure after AVR. However, postoperative EF improves markedly, and most patients enjoy a long postoperative survival without recurrence of heart failure after AVR; thus they should not be denied the benefits of AVR.
左心室功能不全是重度主动脉瓣反流（AR）患者行主动脉瓣置换术（AVR）的指征。然而，重度AR且射血分数（EF）明显降低的患者术后结局尚不清楚。
研究组共纳入1980年至1995年间因单纯AR行AVR的450例患者。将左心室功能明显降低（EF<35%，低EF组，n=43）的患者与左心室功能中度降低（EF 35%至50%，中度EF组，n=134）的患者以及左心室功能正常（EF≥50%，正常EF组，n=273）的患者进行比较。低EF组的手术死亡率（14%）高于中度EF组和正常EF组（分别为6.7%和3.7%，P=0.02）。10年后，低EF组41%±9%的患者存活，而中度EF组和正常EF组分别为56%±5%和70%±3%（P<0.0001）。低EF组10年时25%±9%的患者发生充血性心力衰竭，中度EF组和正常EF组分别为17%±4%和9%±2%（P<0.003）。与正常EF组降低2.3%±10.9%相比，低EF组术后EF提高4.9%±13.8%，中度EF组提高4%±11.9%（分别为P<0.002和P<0.0001）。
重度AR且EF明显降低的患者行AVR后手术死亡率、术后死亡率和充血性心力衰竭发生率均较高。然而，术后EF明显改善，大多数患者术后长期存活且心力衰竭无复发；因此，不应剥夺他们接受AVR的益处。
