Kaneko Tsuyoshi, Ejiofor Julius I, Neely Robert C, McGurk Siobhan, Ivkovic Vladimir, Stevenson Lynne W, Leacche Marzia, Cohn Lawrence H
Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
Ann Thorac Surg. 2016 Jul;102(1):41-7. doi: 10.1016/j.athoracsur.2015.12.068. Epub 2016 Mar 24.
The current study assesses outcomes and risk factors for aortic valve replacement (AVR) for aortic regurgitation (AR) in the setting of markedly reduced left ventricular (LV) function compared with moderately reduced LV function and preserved LV function.
Between January 2002 and June 2013, 485 consecutive patients underwent AVR for severe AR. Overall, 37 of 485 patients (8%) had an LV ejection fraction (EF) less than or equal to 35% (low EF) with median of 30%; 141 of 485 patients (27%) had an LVEF of 36% to 50% (moderate) with median of 45%, and 307 of 485 patients (65%) had an LVEF greater than 50% (preserved) with median of 60%.
Preoperative characteristics were similar across groups, except patients with low EF were older (67.4 ± 12.1 years versus moderate [58.6 ± 15.0 years], p = 0.003 versus preserved [56.9 ± 14.3 years], p = 0.001), more often had reoperations (35.1% versus preserved 19.9%, p = 0.054), and had more concomitant coronary artery bypass grafts (37.6% versus preserved 14.3%, p = 0.001). Operative mortality for the entire cohort was 1.9% (9 or 485) and was similar across groups, 0% in the low EF group, 2.1% (3 of 141) in the moderate group, and 2.0% (6 of 307) in the preserved group (all p > 0.5). Cox proportional hazard modeling indicated that age (hazard ratio [HR] 1.061, p ≤ 0.001), preoperative creatinine (HR 1.478, p ≤ 0.014), history of atrial fibrillation (HR 1.920, p = 0.095), and New York Heart Association class III/IV (HR 2.127, p = 0.004) predicted survival. At median follow-up of 26 months, in the low EF group, the mean LVEF at follow-up was 49.5% ± 10.2% versus baseline 30% ± 4.6% (p ≤ 0.001).
In this series, patients with markedly reduced LV function (LVEF ≤35%) had similar postoperative outcomes and survival as patients with moderate LV dysfunction or preserved LV function.
本研究评估了与左心室（LV）功能中度降低和保留相比，左心室功能显著降低情况下主动脉瓣置换术（AVR）治疗主动脉瓣关闭不全（AR）的结果及危险因素。
2002年1月至2013年6月期间，485例连续患者因严重AR接受AVR。总体而言，485例患者中有37例（8%）左心室射血分数（EF）小于或等于35%（低EF），中位数为30%；485例患者中有141例（27%）LVEF为36%至50%（中度），中位数为45%，485例患者中有307例（65%）LVEF大于50%（保留），中位数为60%。
各亚组术前特征相似，但低EF患者年龄较大（67.4±12.1岁，中度组为[58.6±15.0岁]，p = 0.003，保留组为[56.9±14.3岁]，p = 0.001），再次手术的情况更常见（35.1%，保留组为19.9%，p = 0.054），并且冠状动脉旁路移植术更多（37.6%，保留组为14.3%，p = 0.001）。整个队列的手术死亡率为1.9%（9/485），各亚组相似，低EF组为0%，中度组为2.1%（3/141），保留组为2.0%（6/307）（所有p>0.5）。Cox比例风险模型表明，年龄（风险比[HR]1.061，p≤0.001）、术前肌酐（HR 1.478，p≤0.014）、心房颤动病史（HR 1.920，p = 0.095）和纽约心脏协会III/IV级（HR 2.127，p = 0.004）可预测生存率。在26个月的中位随访期内，低EF组随访时的平均LVEF为49.5%±10.2%，而基线时为30%±4.6%（p≤0.001）。
在本系列研究中，左心室功能显著降低（LVEF≤35%）的患者术后结果和生存率与左心室功能中度降低或保留的患者相似。
