一个19毫米的主动脉瓣假体：这真的有风险吗？
A nineteen-millimetre aortic valve prosthesis: is this really a risk?
作者信息
Lipiec P, Noyez L, Brouwer R M H J
出版信息
Neth Heart J. 2001 Nov;9(8):322-327.
BACKGROUND
Aortic valve replacement in patients with a small aortic root is a subject of ongoing controversy. We summarised our clinical experience with aortic valve replacement with 19 mm valves and combined this with a review of literature.
METHODS
Between January 1994 and December 1999, 603 patients underwent aortic valve replacement; 51 of these patients (8.3%) received a 19 mm heart valve prosthesis. The mean age was 72±9.7 years. Twenty-eight patients had concomitant coronary artery disease, six patients a combined mitral or tricupid valve disease. In four patients, the intervention was a reoperation. The mean EuroSCORE of the total group was 6.4±2.8, and 34 patients had a high operative risk.
RESULTS
Hospital mortality was 7.8% (4/51 patients). Follow-up of 47 hospital survivors was complete. At 12 months the survival was 90%, at 24 months 85% and at 48 months 60%. NYHA class improved at least one class in 35 patients (85%), and 34 patients declared that their quality of life had improved since the operation.
CONCLUSION
Aortic valve replacement with a small (19 mm) prosthesis can be performed with an acceptable operative mortality and results in excellent symptomatic improvement and quality of life.
背景
主动脉根部较小的患者进行主动脉瓣置换术一直存在争议。我们总结了使用19毫米瓣膜进行主动脉瓣置换术的临床经验，并结合文献综述。
方法
1994年1月至1999年12月期间，603例患者接受了主动脉瓣置换术；其中51例患者（8.3%）接受了19毫米心脏瓣膜假体植入。平均年龄为72±9.7岁。28例患者合并冠状动脉疾病，6例患者合并二尖瓣或三尖瓣疾病。4例患者接受再次手术。全组平均欧洲心脏手术风险评估系统（EuroSCORE）评分为6.4±2.8，34例患者手术风险高。
结果
医院死亡率为7.8%（4/51例患者）。47例医院幸存者的随访完整。12个月时生存率为90%，24个月时为85%，48个月时为60%。35例患者（85%）纽约心脏协会（NYHA）心功能分级至少改善一级，34例患者表示自手术以来生活质量有所改善。
结论
使用小尺寸（19毫米）假体进行主动脉瓣置换术可获得可接受的手术死亡率，并能显著改善症状和生活质量。
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