Hanayama Naoji, Fazel Shafie, Goldman Bernard S, Mitoff Peter R, Sever Jeri, Fremes Stephen E
Division of Cardiovascular Surgery, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada.
J Card Surg. 2004 Nov-Dec;19(6):552-8. doi: 10.1111/j.0886-0440.2004.04096.x.
The purpose of this study is to present a comprehensive profile of the trends in aortic valve replacement at a single institution over the past decade. Prospectively collected data concerning 873 patients undergoing aortic valve replacement (AVR), with and without coronary artery bypass grafting (CABG), were analysed. The patients were divided into three time periods: period I, (1990 to 1993); period II, (1994 to 1996); and period III, (1997 to 2000). Actuarial survival of AVR patients with and without CABG at 7 years was 82.9 +/- 2.4% and 79.1 +/- 3.3% (p = 0.17), respectively. Actuarial survival at 7 years for stentless, mechanical, and stented valve patients were 89.5 +/- 2.7%, 85.5 +/- 2.8%, and 76.0 +/- 3.2%, respectively. There was a significant difference in survival between the stentless and stented valve groups (p = 0.014). Age (63.8 +/- 12.9 yrs, 66.2 +/- 11.0 yrs, 67.9 +/- 10.3 yrs; p = 0.01), the incidence of peripheral vascular disease (5.1%, 10.8%, 16.6%; p = 0.001), and the extent of coronary artery disease necessitating CABG (34.0%, 38.8%, 41.0%; p = 0.05) have increased significantly in the later time period. However, operative mortality has remained constant (4.7%, 4.8%, 4.5%; p = 0.9). Moreover, perioperative complications have decreased significantly (27.4%, 18.0, 16.0%; p = 0.001). Multivariate analysis identified more recent time period as independent protective factor for early mortality and morbidity (period I, RR 1.00; period II, RR 0.47; period III, RR 0.40).
本研究的目的是呈现过去十年间某单一机构主动脉瓣置换术趋势的全面概况。对前瞻性收集的873例行主动脉瓣置换术（AVR）患者的数据进行了分析，这些患者有的还进行了冠状动脉旁路移植术（CABG），有的没有。患者被分为三个时间段：第一阶段（1990年至1993年）；第二阶段（1994年至1996年）；第三阶段（1997年至2000年）。行AVR且未行CABG患者以及行AVR并行CABG患者7年的精算生存率分别为82.9±2.4%和79.1±3.3%（p = 0.17）。无支架瓣膜、机械瓣膜和有支架瓣膜患者7年的精算生存率分别为89.5±2.7%、85.5±2.8%和76.0±3.2%。无支架瓣膜组和有支架瓣膜组的生存率存在显著差异（p = 0.014）。后期年龄段（63.8±12.9岁、66.2±11.0岁、67.9±10.3岁；p = 0.01）、外周血管疾病发生率（5.1%、10.8%、16.6%；p = 0.001）以及需要行CABG的冠状动脉疾病程度（34.0%、38.8%、41.0%；p = 0.05）均显著增加。然而，手术死亡率保持不变（4.7%、4.8%、4.5%；p = 0.9）。此外，围手术期并发症显著减少（27.4%、18.0%、16.0%；p = 0.001）。多变量分析确定较近时间段是早期死亡率和发病率的独立保护因素（第一阶段，RR 1.00；第二阶段，RR 0.47；第三阶段，RR 0.40）。
