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在同期主动脉瓣置换术和冠状动脉旁路移植术中,早期和晚期死亡率的主动脉瓣病理类型是否不同?

Is the aortic valve pathology type different for early and late mortality in concomitant aortic valve replacement and coronary artery bypass surgery?

作者信息

Gunay Rafet, Sensoz Yavuz, Kayacioglu Ilyas, Tuygun Abdullah Kemal, Balci Ahmet Yavuz, Kisa Ugur, Demirtas Mahmut Murat, Yekeler Ibrahim

机构信息

Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey.

出版信息

Interact Cardiovasc Thorac Surg. 2009 Oct;9(4):630-4. doi: 10.1510/icvts.2009.206078. Epub 2009 Jul 22.

Abstract

We assessed the effects of aortic valve pathology type on the long-term outcomes of patients who underwent concomitant aortic valve replacement (AVR) and coronary artery bypass grafting (CABG) surgery. We retrospectively reviewed 150 patients who underwent AVR-CABG at our institution between January 1997 and December 2006. We divided patients into aortic stenosis (AS), aortic regurgitation (AR), and mixed-type groups consisting of 98 (65.3%), 20 (13.3%) and 32 (21.3%) patients, respectively. The AS group had more female patients, a higher mean angina class, older mean patient age, increased history of previous myocardial infarction (MI), and smaller valve size compared to other groups. No significant differences were observed among groups in the operative mortality for five or ten-year survival rates. Significant early mortality risk factors included cross-clamp and cardiopulmonary bypass (CBP) time, number of blood transfusion units, chronic obstructive pulmonary disease (COPD), intra-aortic balloon pump (IABP), inotropic drugs, and pacemaker use. Significant late mortality risk factors included intensive care unit (ICU) stay, IABP, stroke, and dialysis. The aortic valve pathology type in patients undergoing concomitant AVR-CABG does not adversely affect survival.

摘要

我们评估了主动脉瓣病变类型对同期接受主动脉瓣置换术(AVR)和冠状动脉旁路移植术(CABG)患者长期预后的影响。我们回顾性分析了1997年1月至2006年12月在我院接受AVR-CABG手术的150例患者。我们将患者分为主动脉狭窄(AS)组、主动脉反流(AR)组和混合型组,分别有98例(65.3%)、20例(13.3%)和32例(21.3%)患者。与其他组相比,AS组女性患者更多、平均心绞痛分级更高、平均患者年龄更大、既往心肌梗死(MI)病史更多且瓣膜尺寸更小。各组在手术死亡率、五年或十年生存率方面未观察到显著差异。显著的早期死亡风险因素包括主动脉阻断和体外循环(CBP)时间、输血量、慢性阻塞性肺疾病(COPD)、主动脉内球囊反搏(IABP)、血管活性药物和起搏器使用。显著的晚期死亡风险因素包括重症监护病房(ICU)住院时间、IABP、中风和透析。同期接受AVR-CABG手术患者的主动脉瓣病变类型不会对生存产生不利影响。

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