Khandhar Sumit, Varadarajan Padmini, Turk Rami, Sampat Unnati, Patel Reena, Kamath Ashvin, Pai Ramdas G
Division of Cardiology, Loma Linda University Medical Center, Loma Linda, California 92354, USA.
Ann Thorac Surg. 2009 Sep;88(3):752-6. doi: 10.1016/j.athoracsur.2009.05.025.
Severe pulmonary hypertension occurs in approximately 10% of patients with severe aortic regurgitation (AR). The potential survival benefit of aortic valve replacement (AVR) in these patients is not known, and was analyzed in a large cohort of patients.
Our echocardiographic data was screened for severe AR patients with severe pulmonary hypertension defined as pulmonary artery systolic pressure of 60 mm Hg or greater. Chart reviews were performed for clinical, pharmacologic, and surgical details, and survival data were analyzed as a function of AVR.
Of the 506 patients with severe AR and measurable pulmonary artery pressures by echocardiography, 83 had severe pulmonary hypertension defined as a pulmonary artery systolic pressure of 60 mm Hg or greater. Severe pulmonary hypertension was associated with lower left ventricular ejection fraction (47% +/- 22% versus 53% +/- 19%, p = 0.006), larger left ventricular size (p = 0.03), and higher grades of mitral regurgitation (2.7 +/- 1.2 versus 1.7 +/- 1.1, p < 0.0001). Of the 83 patients with severe pulmonary hypertension, 32 underwent AVR, which was associated with better survival compared with patients who did not (1-year survival 90% versus 58% and 5-year survival 62% versus 22%, respectively; p = 0.004). After adjusting for comorbidities, AVR remained an independent predictor of better survival (hazard ratio 0.45, 95% confidence interval: 0.22 to 0.92, p = 0.03). This survival benefit of AVR was further supported by propensity score analysis.
Severe pulmonary hypertension occurs in approximately 16% of patients with severe AR and is associated with left ventricular enlargement with dysfunction and resultant mitral regurgitation. Aortic valve replacement is associated with an independent survival benefit in these patients.
严重肺动脉高压发生于约10%的严重主动脉瓣反流（AR）患者中。这些患者行主动脉瓣置换术（AVR）对生存的潜在益处尚不清楚，本研究在一大群患者中对此进行了分析。
我们筛选了经超声心动图诊断为严重AR且伴有严重肺动脉高压（定义为肺动脉收缩压60mmHg或更高）的患者的超声心动图数据。对临床、药物和手术细节进行病历回顾，并根据AVR情况分析生存数据。
在506例经超声心动图测量肺动脉压力的严重AR患者中，83例有严重肺动脉高压，定义为肺动脉收缩压60mmHg或更高。严重肺动脉高压与较低的左心室射血分数（47%±22%对53%±19%，p = 0.006）、较大的左心室大小（p = 0.03）以及更高程度的二尖瓣反流（2.7±1.2对1.7±1.1，p < 0.0001）相关。在83例严重肺动脉高压患者中，32例行AVR，与未行AVR的患者相比，其生存情况更好（1年生存率分别为90%对58%，5年生存率分别为62%对22%；p = 0.004）。在对合并症进行校正后，AVR仍然是生存情况改善的独立预测因素（风险比0.45，95%置信区间：0.22至0.92，p = 0.03）。倾向评分分析进一步支持了AVR的这种生存益处。
严重肺动脉高压发生于约16%的严重AR患者中，与左心室扩大伴功能障碍及由此导致的二尖瓣反流相关。主动脉瓣置换术对这些患者有独立的生存益处。
