再次行主动脉瓣手术：早期和晚期结果。

Redo aortic valve surgery: early and late outcomes.

机构信息

Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany.

出版信息

Ann Thorac Surg. 2011 Apr;91(4):1120-6. doi: 10.1016/j.athoracsur.2010.12.053. Epub 2011 Jan 31.

DOI:10.1016/j.athoracsur.2010.12.053

PMID:21276956

Abstract

BACKGROUND

Repeat aortic valve surgery (rAVS) is usually associated with an increased risk profile due to advanced patient age and comorbidities. We analyzed the current early and late results for isolated rAVS.

METHODS

One hundred fifty-five patients underwent isolated rAVS from November 1994 to April 2008, of which, 86 received isolated redo aortic valve surgery (rAVS without root) and 69 received aortic root replacement (rAVS with root) as the second operation.

RESULTS

Patient age was 58 ± 16 years; 23% were female. The indications for redo surgery were infective endocarditis (27.1%, n = 42), bioprosthetic structural valve dysfunction and degeneration (23.8%, n = 37), mechanical valve nonstructural dysfunction (7.2%, n = 11), paravalvular leak (18.1%, n = 28), aortic dissection (2.6%, n = 4), and aortic aneurysm (7.1%, n = 11). Early mortality was 4.5% (n = 7) for all patients (3.5% for rAVS without root and 5.8% for rAVS with root, p = 0.5). Left ventricular ejection fraction less than 0.30 (odds ratio 9.2, 95% confidence interval [CI] 1.1 to 80.3) and preoperative neurologic dysfunction (odds ratio 22.1, 95% CI 2.3 to 197.4) were found to be the independent predictors for in-hospital mortality according to multivariate analysis. Follow-up was 100% complete with a mean duration of 2.7 ± 2.8 years for all patients. Five-year and eight-year survival was 66% ± 5% and 61% ± 6% for all patients and did not significantly differ between surgical groups. Cox regression analysis revealed the following independent predictors of long-term survival: preoperative New York Heart Association functional class IV (hazard ratio 2.2, 95% CI 1.5 to 3.2, p < 0.01) and infective endocarditis (hazard ratio 2.2, 95% CI 1.4 to 3.1, p < 0.01).

CONCLUSIONS

Repeat isolated aortic valve surgery is associated with respectable outcomes. Follow-up results reveal good long-term survival for this group.

摘要

背景

由于患者年龄较大且合并症较多，再次进行主动脉瓣手术（rAVS）通常与风险增加有关。我们分析了孤立性 rAVS 的近期和远期结果。

方法

1994 年 11 月至 2008 年 4 月期间，共有 155 例患者接受了孤立性 rAVS，其中 86 例接受了孤立性再次主动脉瓣手术（rAVS 无根部），69 例接受了主动脉根部置换术（rAVS 带根部）作为第二次手术。

结果

患者年龄为 58 ± 16 岁，23%为女性。再次手术的指征为感染性心内膜炎（27.1%，n=42）、生物瓣结构性瓣膜功能障碍和退行性变（23.8%，n=37）、机械瓣非结构性功能障碍（7.2%，n=11）、瓣周漏（18.1%，n=28）、主动脉夹层（2.6%，n=4）和主动脉瘤（7.1%，n=11）。所有患者的早期死亡率为 4.5%（n=7）（rAVS 无根部为 3.5%，rAVS 带根部为 5.8%，p=0.5）。多因素分析显示，左心室射血分数小于 0.30（比值比 9.2，95%置信区间 [CI] 1.1 至 80.3）和术前神经功能障碍（比值比 22.1，95%CI 2.3 至 197.4）是院内死亡的独立预测因素。根据多变量分析，所有患者的中位随访时间为 2.7 ± 2.8 年，随访率为 100%。所有患者的 5 年和 8 年生存率分别为 66%±5%和 61%±6%，两组间无显著差异。Cox 回归分析显示，长期生存的独立预测因素为：术前纽约心脏协会心功能分级 IV 级（风险比 2.2，95%CI 1.5 至 3.2，p<0.01）和感染性心内膜炎（风险比 2.2，95%CI 1.4 至 3.1，p<0.01）。