退伍军人事务部人群中同期主动脉瓣置换术和冠状动脉旁路移植术的结果。

Results of concomitant aortic valve replacement and coronary artery bypass grafting in the VA population.

作者信息

Alsoufi Bahaaldin, Karamlou Tara, Slater Matthew, Shen Irving, Ungerleider Ross, Ravichandran Pasala

机构信息

Division of Cardiothoracic Surgery of Portland VA Hospital, Oregon, USA.

出版信息

J Heart Valve Dis. 2006 Jan;15(1):12-8; discussion 18-9.

PMID:16480007

Abstract

BACKGROUND AND AIM OF THE STUDY

Concomitant aortic valve replacement (AVR) and coronary artery bypass grafting (CABG) is an established risk factor for diminished postoperative survival. Results from a VA population were reviewed in order to determine factors influencing early and late survival.

METHODS

Between 1993 and 2003, a total of 401 patients underwent AVR at the authors' institution. Of these patients, 249 (62%; mean age 70.6 years) had combined AVR and CABG. Surgical indications were primarily aortic valve pathology (group A: n = 168; 68%), primarily coronary artery disease (CAD) (group B: n = 55; 22%), and both severe aortic and coronary disease (group C: n = 26; 10%). In total, 177 patients (71%) received a bioprosthesis, and 72 (29%) received a mechanical valve. Short- and long-term outcomes were explored using univariate and multivariable hazard analyses.

RESULTS

Overall operative mortality was 6.4%; mortality for groups A, B and C was 4.8%, 9.1% and 11.5%, respectively. On multivariable analysis, significant factors associated with early-phase mortality were NYHA class IV, diabetes, bioprosthetic valve and combined severe aortic and coronary disease. Survival at one and five years was 86% and 62%, respectively. Five-year survival for groups A, B and C was 71%, 63% and 54%, respectively. Significant associated factors for late-phase mortality were the presence of preoperative peripheral vascular disease (PVD) and cerebrovascular disease (CVD). Factors such as age, prior cardiac surgery, number of grafted coronary arteries, and/or effective orifice area index (EOAI) had no significant effect on outcome.

CONCLUSION

Combined AVR/CABG is a marker for decreased survival. Pre-existing factors such as diabetes, PVD and CVD, as well as poor preoperative NYHA functional status, affected survival. Further investigation is needed to assess the influence of the severity of CAD and EOAI on survival. Thoughtful consideration of all these factors is essential for an accurate prediction of survival, and to determine the appropriate type of aortic prosthesis to be used.

摘要

研究背景与目的

同期进行主动脉瓣置换术（AVR）和冠状动脉旁路移植术（CABG）是术后生存率降低的既定危险因素。回顾了来自退伍军人管理局人群的结果，以确定影响早期和晚期生存的因素。

方法

1993年至2003年期间，共有401例患者在作者所在机构接受了AVR。在这些患者中，249例（62%；平均年龄70.6岁）接受了AVR和CABG联合手术。手术指征主要为主动脉瓣病变（A组：n = 168；68%）、主要为冠状动脉疾病（CAD）（B组：n = 55；22%）以及严重主动脉和冠状动脉疾病（C组：n = 26；10%）。总共177例患者（71%）接受了生物瓣膜，72例（29%）接受了机械瓣膜。使用单变量和多变量风险分析探讨短期和长期结果。

结果

总体手术死亡率为6.4%；A、B和C组的死亡率分别为4.8%、9.1%和11.5%。多变量分析显示，与早期死亡率相关的显著因素为纽约心脏协会（NYHA）IV级、糖尿病、生物瓣膜以及严重主动脉和冠状动脉疾病并存。1年和5年生存率分别为86%和62%。A、B和C组的5年生存率分别为71%、63%和54%。与晚期死亡率相关的显著因素为术前存在外周血管疾病（PVD）和脑血管疾病（CVD）。年龄、既往心脏手术、移植冠状动脉数量和/或有效瓣口面积指数（EOAI）等因素对结果无显著影响。