Baba H, Aoki M, Nishimura Y, Hashimoto M, Okawa Y
Department of Cardiovascular Surgery, Toyohashi Heart Center, Japan.
Kyobu Geka. 2006 Apr;59(4):329-35.
We sought to determine whether the small indexed effective orifice area (EOAI) increased mortality and morbidity after aortic valve replacement (AVR) in patients over 75 years of age. From May 1999 to July 2005, 77 patients underwent isolated AVR for aortic stenosis. They were divided into 3 groups (S-EOAI : EOAI < or = 0.7 cm2/m2, M-EOAI : 0.7 cm2/m2 <EOAI < or = 0.85 cm2/ m2, L-EOAI : 0.85cm2/m2 <EOAI) for evaluation. We examined the body surface area (BSA), EOAI, and the left ventricular (LV) mass index (LVMI). We found that patients with S-EOAI had less symptomatic improvement (p <0.05, vs L-EOAI) and LV mass regression (p< 0.01, vs L-EOAI). But, their average New York Heart Association (NYHA) class was improved significantly (2.3 +/- 0.8 vs 1.8 +/- 0.7 : preoperative vs postoperative, p=0.001). Furthermore, severe patient-prosthesis mismatch (PPM) had no significant negative impacts on the freedom of valve-related complications (75.1% : S-EOAI group vs 92.0% : L-EOAI group) and the 5-year survival (84.9% : S-EOAI group vs 87.8% : L-EOAI group). In elderly patients, the average NYHA class was 1.9 +/- 0.6 postoperatively (p<0.0001 vs preoperative) and the LVMI showed significant regression (p<0.0001) despite an average EOAI of 0.73 +/- 0.13 cm2/m2. It is important to consider whether the benefits of avoiding PPM overcome the drawbacks of other complicated techniques. In this study, we found that moderate PPM (0.7 cm2/m2 < or = EOAI) is acceptable to elderly patients.
我们试图确定，对于75岁以上的患者，较小的经指数化计算的有效瓣口面积（EOAI）是否会增加主动脉瓣置换术（AVR）后的死亡率和发病率。从1999年5月至2005年7月，77例患者因主动脉瓣狭窄接受单纯AVR手术。他们被分为3组（小EOAI组：EOAI≤0.7cm²/m²，中EOAI组：0.7cm²/m²＜EOAI≤0.85cm²/m²，大EOAI组：0.85cm²/m²＜EOAI）进行评估。我们检查了体表面积（BSA）、EOAI和左心室（LV）质量指数（LVMI）。我们发现，小EOAI组患者的症状改善较少（与大EOAI组相比，p＜0.05），左心室质量减轻也较少（与大EOAI组相比，p＜0.01）。但是，他们的纽约心脏协会（NYHA）平均分级有显著改善（术前2.3±0.8 vs术后1.8±0.7，p = 0.001）。此外，严重的患者-人工瓣膜不匹配（PPM）对瓣膜相关并发症的发生率（小EOAI组75.1% vs大EOAI组92.0%）和5年生存率（小EOAI组84.9% vs大EOAI组87.8%）没有显著负面影响。在老年患者中，尽管平均EOAI为0.73±0.13cm²/m²，但术后NYHA平均分级为1.9±0.6（与术前相比，p＜0.0001），LVMI有显著减轻（p＜0.0001）。考虑避免PPM的益处是否超过其他复杂技术的弊端很重要。在本研究中，我们发现中度PPM（0.7cm²/m²≤EOAI）对老年患者是可以接受的。
