Verhoye Jean Ph, Merlicco Franceseca, Sami Ibrahim M, Cappabianca Giangiuseppe, Lecouls Hervé, Corbineau Hervé, Langanay Thierry, Leguerrier Alain
Department of Thoracic and Cardiovascular Surgery, University Hospital, Ponchaillou, Rennes, France.
J Heart Valve Dis. 2006 Jul;15(4):474-8.
The study aim was to examine, retrospectively, the risk of accelerated progression of aortic stenosis (AS) and outcome after aortic valve replacement (AVR) in patients who had undergone previous coronary artery bypass graft (CABG) surgery.
Between 1994 and 2004, 81 patients with mild-to-moderate AS at the time of CABG underwent subsequent AVR. The mean EuroScore was 10.8 +/- 1.8. The population was divided into three subgroups according to the time interval between AVR and CABG: group A, < 5 years (n = 23); group B, 5-10 years (n = 34); and group C, > 10 years (n = 24).
Mean age at the time of CABG was 70 +/- 5, 64 +/- 6 and 58 +/- 5 years in groups A, B, and C, respectively. The peak transvalvular gradient was < or = 30 mmHg in 65 patients (80.2%), and 30-50 mmHg in 16 (19.7%). Operative mortality after AVR was 16% in the overall population (30%, 11.7%, and 8.6% in groups A, B, and C, respectively). The mean time interval between CABG and AVR was 8.9 +/- 5.2 years. By multivariate analysis, a peak transvalvular gradient > or = 30 mmHg (p = 0.003), moderate calcifications with moderately-to-severely limited valve motion (p = 0.05), and left ventricular hypertrophy (LVH) (p = 0.005) were independent predictors of AVR within five years of CABG surgery. Systemic vascular atherosclerotic disease was a predictor of rapid disease progression by univariate analysis, and a predictor of operative mortality by multivariate analysis.
Because of the high mortality associated with repeat operations within five years, AVR should be considered at the time of CABG in patients aged < or = 75 years, with a peak transvalvular gradient > 30 mmHg, moderately prominent calcifications with moderately to severely limited valve motion, and LVH.
本研究旨在回顾性分析既往接受过冠状动脉旁路移植术（CABG）的患者发生主动脉瓣狭窄（AS）加速进展的风险以及主动脉瓣置换术（AVR）后的结局。
1994年至2004年间，81例在CABG时患有轻至中度AS的患者随后接受了AVR。平均欧洲心脏手术风险评估系统（EuroScore）评分为10.8±1.8。根据AVR与CABG之间的时间间隔，将患者分为三个亚组：A组，间隔<5年（n = 23）；B组，间隔5 - 10年（n = 34）；C组，间隔>10年（n = 24）。
CABG时A组、B组和C组的平均年龄分别为70±5岁、64±6岁和58±5岁。65例患者（80.2%）的跨瓣压差峰值≤30 mmHg，16例患者（19.7%）的跨瓣压差峰值为30 - 50 mmHg。AVR术后总体人群的手术死亡率为16%（A组、B组和C组分别为30%、11.7%和8.6%）。CABG与AVR之间的平均时间间隔为8.9±5.2年。多因素分析显示，跨瓣压差峰值≥30 mmHg（p = 0.003）、中度钙化伴中度至重度瓣膜活动受限（p = 0.05）以及左心室肥厚（LVH）（p = 0.005）是CABG术后五年内进行AVR的独立预测因素。全身血管动脉粥样硬化疾病在单因素分析中是疾病快速进展的预测因素，在多因素分析中是手术死亡率的预测因素。
由于五年内再次手术相关的高死亡率，对于年龄≤75岁、跨瓣压差峰值>30 mmHg、中度明显钙化伴中度至重度瓣膜活动受限以及LVH的患者，应在CABG时考虑进行AVR。
