Department of Internal Medicine, Division of Cardiology, Baylor University Medical Center, Dallas, Texas, USA.
Am J Cardiol. 2012 May 1;109(9):1334-40. doi: 10.1016/j.amjcard.2011.12.028. Epub 2012 Mar 1.
Reports differ regarding the effect of concomitant coronary artery bypass grafting (CABG) in patients who undergo aortic valve replacement (AVR) for aortic stenosis (AS), and no reports have described the effect of aortic valve structure in patients who undergo AVR for AS. A total of 871 patients aged 24 to 94 years (mean 70) whose AVR for AS was their first cardiac operation, with or without first concomitant CABG, were included. Patients who underwent mitral valve procedures were excluded. In comparison with the 443 patients (51%) who did not undergo CABG, the 428 (49%) who underwent concomitant CABG were significantly older, were more often male, had lower transvalvular peak systolic pressure gradients and larger valve areas, had lower frequencies of congenitally malformed aortic valves, had lighter valves by weight, had higher frequencies of systemic hypertension, and had longer stays in the hospital after AVR. Early and late (to 10 years) mortality were similar by propensity-adjusted analysis in patients who did and did not undergo concomitant CABG. Congenitally unicuspid or bicuspid valves occurred in approximately 90% of those aged 21 to 50, in nearly 70% in those aged 51 to 70 years, and in just over 30% in those aged 71 to 95 years. Unadjusted and adjusted survival was significantly higher in patients with unicuspid or bicuspid valves compared to those with tricuspid valves. In conclusion, although concomitant CABG had no effect on the adjusted probability of survival, the type of aortic valve (unicuspid or bicuspid vs tricuspid) significantly affected the unadjusted and adjusted probability of survival.
关于在主动脉瓣狭窄(AS)患者中进行主动脉瓣置换(AVR)时同时进行冠状动脉旁路移植术(CABG)的效果,报告结果存在差异,并且尚无报告描述在 AS 患者中进行 AVR 时主动脉瓣结构的影响。共纳入 871 例年龄在 24 至 94 岁(平均 70 岁)的患者,这些患者均因 AS 而首次接受 AVR 手术,其中包括或不包括首次同时进行的 CABG。排除了行二尖瓣手术的患者。与未行 CABG 的 443 例(51%)患者相比,同时行 CABG 的 428 例(49%)患者年龄较大,更多为男性,跨瓣收缩期峰值压力梯度和瓣口面积较小,先天性畸形主动脉瓣的发生率较低,瓣叶重量较轻,高血压的发生率较高,AVR 后住院时间较长。通过倾向评分调整分析,在同时行和未行 CABG 的患者中,早期和晚期(10 年)死亡率相似。在 21 至 50 岁的患者中,约有 90%的患者为先天性单瓣或双瓣,51 至 70 岁的患者中近 70%,71 至 95 岁的患者中超过 30%。未调整和调整后的生存率在单瓣或双瓣患者中明显高于三尖瓣患者。总之,尽管同时进行 CABG 对调整后的生存率无影响,但主动脉瓣类型(单瓣或双瓣与三尖瓣)显著影响了未调整和调整后的生存率。
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