Division of Cardiothoracic Surgery, Northwestern University, Feinberg School of Medicine, Bluhm Cardiovascular Institute at Northwestern Memorial Hospital, Chicago, Illinois, USA.
Ann Thorac Surg. 2010 Mar;89(3):751-6. doi: 10.1016/j.athoracsur.2009.11.024.
Transcatheter aortic valve implantation may become a potential treatment for high-risk patients with aortic stenosis (AS). We analyzed our contemporary series of isolated aortic valve replacement (AVR) for AS to determine implications for patients referred for AVR.
From April 2004 through December 2008, 190 patients (mean age, 68 years; 68% men) underwent isolated AVR for AS. Mean ejection fraction was 0.58. Sixty-one percent underwent minimally invasive AVR and 18% were reoperations. Twenty-one percent were aged 80 years or older, and 34% were in New York Heart Association functional class III-IV. Estimated operative mortality was 3.6%.
Thirty-day mortality was 0%. One in-hospital death (0.5%) occurred from complications of an esophageal perforation. Reoperation for bleeding occurred in 4.7%. Acute renal failure developed in 2.1%. Actuarial survival was 97% at 1 year and 94% at 3 years. Hospital length of stay was 7.0 days for patients aged 80 and older vs 5.0 days (p < 0.001), and they were less likely to be discharged to home (50% vs 83%, p < 0.001).
Contemporary results show that AVR for AS can be performed with low operative mortality and morbidity, although patients aged 80 years and older are at increased risk of prolonged recovery. Transcatheter aortic valve implantation may be an alternative for high-risk patients, but AVR is still appropriate for low-risk patients. The low risk of AVR supports the argument that asymptomatic patients who have a high likelihood of progression of AS may be considered for earlier surgical referral.
经导管主动脉瓣植入术可能成为治疗高危主动脉瓣狭窄（AS）患者的潜在手段。我们分析了同期单纯主动脉瓣置换术（AVR）治疗 AS 的系列病例，以明确对接受 AVR 治疗患者的影响。
2004 年 4 月至 2008 年 12 月，190 例（平均年龄 68 岁，68%为男性）患者因 AS 接受了单纯 AVR。平均射血分数为 0.58。61%行微创 AVR，18%为再次手术。21%患者年龄在 80 岁及以上，34%为纽约心脏协会心功能 III-IV 级。预计手术死亡率为 3.6%。
30 天死亡率为 0%。1 例院内死亡（0.5%）死于食管穿孔并发症。4.7%患者因出血行再次手术。2.1%发生急性肾功能衰竭。1 年和 3 年的生存率分别为 97%和 94%。80 岁及以上患者的住院时间为 7.0 天，显著长于 5.0 天（p<0.001），且出院回家的比例较低（50% vs 83%，p<0.001）。
目前的结果表明，AVR 治疗 AS 可获得较低的手术死亡率和发病率，尽管 80 岁及以上患者的恢复时间延长风险较高。经导管主动脉瓣植入术可能是高危患者的替代治疗手段，但 AVR 仍然适用于低危患者。AVR 的低风险支持了这样一种观点，即进展为 AS 可能性较高的无症状患者可考虑早期手术转诊。
