严重主动脉瓣反流伴左心室射血分数降低：单纯主动脉瓣置换术与联合手术的结局。
Severe aortic regurgitation and reduced left ventricular ejection fraction: outcomes after isolated aortic valve replacement and combined surgery.
机构信息
Cardiology Department, Thorax Institute, Hospital Clinic, Institut d'Investigaciones Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
出版信息
J Heart Lung Transplant. 2010 Apr;29(4):445-8. doi: 10.1016/j.healun.2009.09.018. Epub 2009 Dec 24.
BACKGROUND
In patients with severe aortic regurgitation and reduced left ventricular ejection fraction (LVEF), uncertainty remains whether to recommend aortic valve replacement (AVR) over heart transplantation, especially when mitral regurgitation and/or coronary heart disease coexist.
METHODS
We assessed outcomes in 26 consecutive AVR patients aged </=70 years with severe aortic regurgitation and reduced LVEF, comparing the group undergoing isolated AVR with the group requiring combined surgery.
RESULTS
The difference in mortality and morbidity between the groups was 10% vs 6%, which was not significant (p = 0.6 in both cases). Also observed was a significant improvement in functional class and a reduction in LV end-diastolic diameter from a median value of 69 to 64 mm in the isolated AVR group and to 66 mm in the combined group (p < 0.05).
CONCLUSIONS
AVR in patients with symptomatic severe aortic regurgitation and reduced LVEF is feasible, even in the presence of concomitant mitral regurgitation and/or coronary heart disease requiring a combined surgical procedure.
背景
在严重主动脉瓣反流和左心室射血分数（LVEF）降低的患者中，对于是否推荐主动脉瓣置换（AVR）而非心脏移植，仍存在不确定性，特别是当合并二尖瓣反流和/或冠心病时。
方法
我们评估了 26 例连续接受 AVR 的年龄<=70 岁、严重主动脉瓣反流和 LVEF 降低的患者的结局，比较了仅行 AVR 的组与需要联合手术的组。
结果
两组之间的死亡率和发病率差异为 10%比 6%，无显著差异（p=0.6）。还观察到功能分级显著改善，LV 舒张末期直径从孤立 AVR 组的中位数 69 降至 64mm，联合组降至 66mm（p<0.05）。
结论
即使存在需要联合手术的合并二尖瓣反流和/或冠心病，有症状的严重主动脉瓣反流和降低的 LVEF 的患者行 AVR 也是可行的。
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