Levy Franck, Laurent Marcel, Monin Jean Luc, Maillet Jean Michel, Pasquet Agnès, Le Tourneau Thierry, Petit-Eisenmann Hélène, Gori Mauro, Jobic Yannick, Bauer Fabrice, Chauvel Christophe, Leguerrier Alain, Tribouilloy Christophe
Department of Cardiology, INSERM, ERI-12, University Hospital, Amiens, France.
J Am Coll Cardiol. 2008 Apr 15;51(15):1466-72. doi: 10.1016/j.jacc.2007.10.067.
We evaluated a large multicenter series of patients operated on for low-flow/low-gradient aortic stenosis (LF/LGAS) to stratify the operative risk, assess whether perioperative mortality has decreased over recent years, and analyze the post-operative outcome.
Although LF/LGAS is classically associated with a high operative risk, few data are available concerning the results of surgery in this setting.
A total of 217 consecutive patients (168 men, 77%) with severe aortic stenosis (area <1 cm(2)), low ejection fraction (EF) (<or=35%), and low mean gradient (MG) (<or=30 mm Hg) who underwent aortic valve replacement (AVR) between 1990 and 2005 were included.
Perioperative mortality was 16% and decreased dramatically from 20% in the 1990 to 1999 period to 10% in the 2000 to 2005 period. Higher European System for Cardiac Operative Risk Evaluation score (EuroSCORE), very low MG and EF, New York Heart Association functional class III or IV, history of congestive heart failure, and multivessel coronary artery disease (MVD) were associated with perioperative mortality. On multivariate analysis, very low pre-operative MG and MVD were predictors of excess perioperative mortality. In the subgroup of patients with dobutamine stress echocardiography, the absence of contractile reserve was a strong predictor of perioperative mortality. Overall 5-year survival rate was 49 +/- 4%. Lower MG, higher EuroSCORE, prior atrial fibrillation, and MVD were identified as independent predictors of overall long-term mortality.
In view of the very poor prognosis of unoperated patients, the current operative risk, and the long-term outcome after surgery, AVR is the treatment of choice in the majority of cases of LF/LGAS.
我们评估了一系列接受低流量/低跨瓣压差主动脉瓣狭窄（LF/LGAS）手术的多中心患者，以分层手术风险，评估近年来围手术期死亡率是否有所下降，并分析术后结果。
虽然LF/LGAS传统上与高手术风险相关，但关于这种情况下手术结果的数据很少。
纳入了1990年至2005年间连续217例严重主动脉瓣狭窄（瓣口面积<1 cm²）、低射血分数（EF）（≤35%）和低平均跨瓣压差（MG）（≤30 mmHg）并接受主动脉瓣置换术（AVR）的患者（168例男性，占77%）。
围手术期死亡率为16%，从1990年至1999年期间的20%显著下降至2000年至2005年期间的10%。欧洲心脏手术风险评估系统（EuroSCORE）评分较高、极低的MG和EF、纽约心脏协会心功能Ⅲ或Ⅳ级、充血性心力衰竭病史以及多支冠状动脉疾病（MVD）与围手术期死亡率相关。多因素分析显示，术前极低的MG和MVD是围手术期死亡增加的预测因素。在多巴酚丁胺负荷超声心动图检查的患者亚组中，无收缩储备是围手术期死亡的有力预测因素。总体5年生存率为49±4%。较低的MG、较高的EuroSCORE、既往房颤和MVD被确定为总体长期死亡率的独立预测因素。
鉴于未经手术治疗患者的预后极差、当前的手术风险以及术后的长期结果，AVR是大多数LF/LGAS病例的首选治疗方法。
