Talwar Sachin, Saikrishna Cheemalapati, Saxena Anita, Kumar Arkalgud Sampath
Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
Ann Thorac Surg. 2005 Jun;79(6):1921-5. doi: 10.1016/j.athoracsur.2004.11.042.
The aim of this study is to assess the long-term results of aortic valve repair in patients with rheumatic aortic valve disease.
From April 1991 through December 2003, 61 patients with rheumatic aortic valve disease underwent aortic valve repair. Mean age was 23.7 +/- 9.3 years (range, 6 to 53 years). Thirty-nine (63.9%) patients were in New York Heart Association functional class III. Reparative procedures included cuspal thinning (n = 59), commissurotomy (n = 45), subcommissural annuloplasty (n = 24), commissural plication (n = 12), perforation closure using pericardium (n = 2), and decalcification of cusps (n = 2). Associated procedures included mitral valve repair (n = 36) and tricuspid valve repair with mitral valve repair (n = 5).
Early mortality was 4.9% (3 patients). Mean follow-up was 93.8 +/- 46.4 months (range, 6 to 160 months, median, 103 months). Forty-six survivors (65%) had no or trivial or mild aortic regurgitation. Four patients required reoperation for valve dysfunction. There were no late deaths. Actuarial and reoperation-free survival, at 160 months, was 95.2% +/- 2.8% and 85.4% +/- 6.7%, respectively. Freedom from significant aortic stenosis or regurgitation was 52.4% +/- 16.9%.
Aortic valve repair in patients with rheumatic aortic valve disease is feasible and yields gratifying long-term results.
本研究旨在评估风湿性主动脉瓣疾病患者主动脉瓣修复的长期效果。
从1991年4月至2003年12月，61例风湿性主动脉瓣疾病患者接受了主动脉瓣修复。平均年龄为23.7±9.3岁（范围6至53岁）。39例（63.9%）患者为纽约心脏协会心功能Ⅲ级。修复手术包括瓣叶削薄（n = 59）、交界切开术（n = 45）、交界下环缩术（n = 24）、交界折叠术（n = 12）、用心包修补穿孔（n = 2）以及瓣叶脱钙（n = 2）。相关手术包括二尖瓣修复（n = 36）和二尖瓣修复联合三尖瓣修复（n = 5）。
早期死亡率为4.9%（3例患者）。平均随访时间为93.8±46.4个月（范围6至160个月，中位数103个月）。46例存活者（65%）无或仅有轻微或轻度主动脉瓣反流。4例患者因瓣膜功能障碍需要再次手术。无晚期死亡病例。160个月时的精算生存率和无需再次手术生存率分别为95.2%±2.8%和85.4%±6.7%。无严重主动脉瓣狭窄或反流的比例为52.4%±16.9%。
风湿性主动脉瓣疾病患者的主动脉瓣修复是可行的，并且能产生令人满意的长期效果。
