Ingvarsdóttir Inga Lára, Viktorsson Sindri Aron, Hreinsson Kári, Sigurdsson Martin Ingi, Helgadóttir Sólveig, Arnórsson Pórarinn, Danielsen Ragnar, Gudbjartsson Tómas
Laeknabladid. 2011 Oct;97(10):523-7.
Information on surgical outcome of aortic valve replacement (AVR) has not been available in Iceland. We therefore studied the indications, short-term complications and operative mortality in Icelandic patients that underwent AVR with aortic stenosis.
This was a retrospective study including all patients that underwent AVR for aortic stenosis at Landspitali between 2002 and 2006, a total of 156 patients (average age 71.7 years, 64.7% males). Short term complications and operative mortality (≤ 30 days) were registered and risk factors analysed with multivariate analysis.
The most common symptoms before AVR were dyspnea (86.9%) and angina pectoris (52.6%). Preop. max aortic valve pressure gradient was on average 74 mmHg, the left ventricular ejection fraction 57.2% and EuroSCORE (st) 6.9%. The average operating time was 282 min and concomitant CABG was performed in 55% of the patients and mitral valve surgery in nine. A bioprothesis was implanted in 127 of the patients (81.4%), of which 102 were stentless valves, and a mechanical valve in 29 (18.6%) cases. The mean prosthesis size was 25.6 mm (range 21-29). Atrial fibrillation (78.0%) and acute renal injury (36.0%) were the most common complications and 20 patients (13.0%) developed multiple-organ failure. Twenty-six patients (17.0%) needed reoperation due to bleeding. Median hospital stay was 13 days and operative mortality was 6.4%.
The rate of short term complications following AVR was relatively high, including reoperations for bleeding and atrial fibrillation. Operative mortality is twice that of CABG, which is in line with other studies.
冰岛此前尚无主动脉瓣置换术（AVR）手术结果的相关信息。因此，我们研究了冰岛接受主动脉狭窄主动脉瓣置换术患者的手术指征、短期并发症及手术死亡率。
这是一项回顾性研究，纳入了2002年至2006年间在Landspitali医院接受主动脉狭窄主动脉瓣置换术的所有患者，共156例（平均年龄71.7岁，男性占64.7%）。记录短期并发症及手术死亡率（≤30天），并通过多因素分析对危险因素进行分析。
主动脉瓣置换术前最常见的症状为呼吸困难（86.9%）和心绞痛（52.6%）。术前主动脉瓣最大压力阶差平均为74 mmHg，左心室射血分数为57.2%，欧洲心脏手术风险评估系统（EuroSCORE）（标准化）为6.9%。平均手术时间为282分钟，55%的患者同时进行了冠状动脉旁路移植术（CABG），9例患者进行了二尖瓣手术。127例患者（81.4%）植入了生物瓣膜，其中102例为无支架瓣膜，29例（18.6%）植入了机械瓣膜。人工瓣膜平均尺寸为25.6 mm（范围21 - 29）。房颤（78.0%）和急性肾损伤（36.0%）是最常见的并发症，20例患者（13.0%）发生多器官功能衰竭。26例患者（17.0%）因出血需要再次手术。中位住院时间为13天，手术死亡率为6.4%。
主动脉瓣置换术后短期并发症发生率相对较高，包括因出血和房颤进行的再次手术。手术死亡率是冠状动脉旁路移植术的两倍，这与其他研究结果一致。
