Parikh Roosha, Goodman Andrew L, Barr Tyler, Sabik Joseph F, Svensson Lars G, Rodriguez Luis Leonardo, Lytle Bruce W, Grimm Richard A, Griffin Brian P, Desai Milind Y
Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
J Thorac Cardiovasc Surg. 2015 Jun;149(6):1558-66.e1. doi: 10.1016/j.jtcvs.2015.03.008. Epub 2015 Mar 11.
We sought to assess predictors of mortality in consecutive patients with severe aortic stenosis undergoing aortic valve replacement and to determine whether there are differences in mortality, separated on the basis of different aortic stenosis subtypes and left ventricular stroke volume index.
We studied 875 patients (aged 69 ± 12 years, 67% were men) with severe aortic stenosis (aortic valve area ≤ 1 cm(2)) who underwent aortic valve replacement between January 2007 and December 2008 (excluding other severe valve disease, balloon aortic valvuloplasty, and transcatheter aortic valve replacement). Clinical and echocardiographic data were recorded. Left ventricular stroke volume index was measured as left ventricular outflow tract velocity time integral × left ventricular outflow tract area/body surface area. Patients were classified into the following subtypes: (1) standard severe (n = 536, left ventricular ejection fraction ≥ 50% and mean gradient ≥ 40 mm Hg); (2) paradoxic severe (n = 152, left ventricular ejection fraction ≥ 50%, mean gradient <40 mm Hg and left ventricular stroke volume index <35 mL/m(2)); and (3) low left ventricular ejection fraction severe (n = 187, ejection fraction <50%). Society of Thoracic Surgeons score and all-cause mortality were recorded.
At 4.8 ± 2 years, 153 patients (18%) died (30-day mortality 1.8%). On multivariable Cox analysis, age (hazard ratio [HR], 1.49), New York Heart Association class (HR, 1.52), prior cardiac surgery (HR, 1.41), aortic stenosis subtypes (standard severe reference HR, 1; paradoxic severe HR, 1.48; and low left ventricular ejection fraction severe HR, 2.03), and reduced glomerular filtration rate (HR, 1.17) were associated with higher long-term mortality (P < .05).
In patients with severe aortic stenosis undergoing aortic valve replacement, patients with standard severe aortic stenosis had better long-term survival than those with paradoxic severe or low left ventricular ejection fraction severe aortic stenosis.
我们试图评估接受主动脉瓣置换术的连续性重度主动脉瓣狭窄患者的死亡率预测因素，并确定基于不同主动脉瓣狭窄亚型和左心室每搏量指数的死亡率是否存在差异。
我们研究了875例重度主动脉瓣狭窄（主动脉瓣面积≤1平方厘米）患者（年龄69±12岁，67%为男性），这些患者在2007年1月至2008年12月期间接受了主动脉瓣置换术（不包括其他严重瓣膜疾病、球囊主动脉瓣成形术和经导管主动脉瓣置换术）。记录临床和超声心动图数据。左心室每搏量指数的测量方法为左心室流出道速度时间积分×左心室流出道面积/体表面积。患者被分为以下亚型：（1）标准重度（n = 536，左心室射血分数≥50%且平均压差≥40 mmHg）；（2）矛盾性重度（n = 152，左心室射血分数≥50%，平均压差<40 mmHg且左心室每搏量指数<35 mL/m²）；（3）低左心室射血分数重度（n = 187，射血分数<50%）。记录胸外科医师协会评分和全因死亡率。
在4.8±2年时，153例患者（18%）死亡（术后30天死亡率为1.8%）。多变量Cox分析显示，年龄（风险比[HR]，1.49）、纽约心脏病协会分级（HR，1.52）、既往心脏手术史（HR，1.41）、主动脉瓣狭窄亚型（标准重度作为参照，HR为1；矛盾性重度HR，1.48；低左心室射血分数重度HR，2.03）以及肾小球滤过率降低（HR，1.17）与较高的长期死亡率相关（P<.05）。
在接受主动脉瓣置换术的重度主动脉瓣狭窄患者中，标准重度主动脉瓣狭窄患者的长期生存率优于矛盾性重度或低左心室射血分数重度主动脉瓣狭窄患者。
