Division of Cardiovascular Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
J Thorac Cardiovasc Surg. 2011 Sep;142(3):595-601, 601.e1-2. doi: 10.1016/j.jtcvs.2010.05.056. Epub 2011 Jan 17.
To assess the influence of gender on mortality after aortic valve replacement for aortic stenosis.
A retrospective analysis was performed on data prospectively collected from all patients undergoing aortic valve replacement for aortic stenosis. Multivariate regression analysis was performed to evaluate the effect of 22 preoperative and operative variables on early, late, and overall mortality.
Aortic valve replacement was performed in 3343 patients with aortic stenosis between 1982 and 2003. The female patients were older, with a smaller body mass index. The women were less likely to have diabetes, chronic obstructive pulmonary disease, previous myocardial infarction, or left ventricular ejection fraction <35% but were more likely to have hypertension or a New York Heart Association III-IV classification. The female patients received a smaller prosthetic valve, with a smaller effective orifice area index (EOAI). The mean follow-up period was 6.18 ± 4.96 years, with a total of 2066.142 years of follow-up. The independent predictors of early mortality for the male patients included age, concomitant surgical revascularization, congestive heart failure, and valve size of ≤21 mm. The independent predictors of late mortality for the male patients included age, concomitant surgical revascularization, diabetes, renal failure, chronic obstructive pulmonary disease, congestive heart failure, and a bioprosthetic valve. The independent predictors of overall mortality for the male patients included age, concomitant surgical revascularization, diabetes, renal failure, heart failure, and valve size of ≤21 mm. For the female patients, the risk factors for early mortality included body mass index <25 kg/m(2); for late mortality included age, concomitant surgical revascularization, New York Heart Association class III-IV, and diabetes; and for overall mortality included age, concomitant surgical revascularization, New York Heart Association class III-IV, and renal failure. Furthermore, male gender was an independent predictor of late (but not early or overall) mortality.
The independent predictors of mortality after aortic valve replacement for aortic stenosis differed between the male and female patients. Male gender increased the risk of late mortality, and a valve size of ≤21 mm increased the risk of early and overall mortality among the male patients only. These differences need to be taken into consideration preoperatively and require consideration during operative management.
评估性别对主动脉瓣狭窄患者主动脉瓣置换术后死亡率的影响。
对 1982 年至 2003 年间所有因主动脉瓣狭窄接受主动脉瓣置换术的患者前瞻性收集的数据进行回顾性分析。采用多变量回归分析评估 22 个术前和手术变量对早期、晚期和总体死亡率的影响。
共对 3343 例主动脉瓣狭窄患者进行了主动脉瓣置换术。女性患者年龄较大，体重指数较小。女性患者患糖尿病、慢性阻塞性肺疾病、既往心肌梗死或左心室射血分数<35%的可能性较小，但患高血压或纽约心脏协会 III-IV 级的可能性较大。女性患者接受的人工瓣膜较小，有效瓣口面积指数（EOAI）较小。平均随访时间为 6.18±4.96 年，随访总时间为 2066.142 年。男性患者早期死亡率的独立预测因素包括年龄、同期手术血运重建、充血性心力衰竭和瓣膜尺寸≤21mm。男性患者晚期死亡率的独立预测因素包括年龄、同期手术血运重建、糖尿病、肾功能衰竭、慢性阻塞性肺疾病、充血性心力衰竭和生物瓣。男性患者全因死亡率的独立预测因素包括年龄、同期手术血运重建、糖尿病、肾功能衰竭、心力衰竭和瓣膜尺寸≤21mm。对于女性患者，早期死亡率的危险因素包括体重指数<25kg/m2；晚期死亡率的危险因素包括年龄、同期手术血运重建、纽约心脏协会心功能分级 III-IV 级和糖尿病；全因死亡率的危险因素包括年龄、同期手术血运重建、纽约心脏协会心功能分级 III-IV 级和肾功能衰竭。此外，男性是晚期（而非早期或全因）死亡率的独立预测因素。
主动脉瓣狭窄患者主动脉瓣置换术后死亡率的独立预测因素在男性和女性患者之间存在差异。男性性别增加了晚期死亡率的风险，而瓣膜尺寸≤21mm 仅增加了男性患者的早期和全因死亡率的风险。这些差异需要在术前考虑，并在手术管理中考虑。
