Fan Xing Li, Zhang Jiajun, Wang Chong, Chong Hongmei, Zhang Guanxin, Xue Qing, Tang Yangfeng, Han Lin
Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
Department of Cardiovascular Surgery, Xiongke Hospital, Shanghai Jiao Tong University, Shanghai, China.
Heart Surg Forum. 2017 Jul 20;20(4):E124-E128. doi: 10.1532/hsf.1709.
It is well-documented that stroke volume and gradient are indexed to classify patients with aortic stenosis into several phenotypes. The purpose of the present study was to estimate the impact of stroke volume and gradient on the clinical outcome of patients with AS who have undergone aortic valve replacement. Methods: A total of 154 consecutive patients were studied. They all had severe aortic stenosis (aortic valve area [AVA] ≤ 1 cm², left ventricular ejection fraction [LVEF] ≥ 50%) and underwent aortic valve replacement (AVR) from January 1, 2004 to December 31, 2010. Clinical and echocardiography data was collected. According to stroke volume index (SVi), low flow (LF, SVi < 35 mL/m²) and normal flow (NF, SVi ≥ 35 mL/m²) were defined, and according to transvalvular pressure gradient, low gradient (LG, gradient < 40 mmHg) and high gradient (HG, gradient ≥ 40 mmHg) were also defined. Based on the above classification, patients were separated into four groups: NF/HG (59 patients), NF/LG (30 patients), LF/HG (40 patients) and LF/LG (25 patients). To estimate the discrepancy between patients with bicuspid aortic valve (BAV) and normal 3-leaflets aortic valve, 154 cases were divided into 2 groups: BAV group and 3-leaflets group. In-hospital mortality and overall survival were followed up. The risk factors of in-hospital mortality and overall survival were estimated by logistic regression analysis and Cox regression analysis. Results: The mean follow-up time was 59 ± 32 months of 154 patients among whom the in-hospital mortality of NF/HG was 1.7% compared with NF/LG (6.7%), LF/HG (12.5%) and LF/LG (10.5%). The overall survival rates among the four groups were NF/HG (72%), NF/LG (92%), LF/HG (55%) and LF/LG (84%). The 5-year survival rate was lower in the BAV group than in the 3-leaflets group (78% and 93%; P < .05). The independent value for the in-hospital mortality included atrial fibrillation, concomitant coronary artery bypass graft, cardiac index, and bicuspid aortic valve. The independent factors for the overall survival included valvulo-arterial impedance, time of cardiopulmonary bypass, atrial fibrillation, bicuspid aortic valve, and concomitant coronary artery bypass graft. Conclusion: The in-hospital outcome of LF/LG is worse than NF/HG and NF/LG, but similar to LF/HG. For the overall outcome, LF/LG is better than NF/HG and LF/HG, but worse than NF/LG. Patients with BAV exhibit worse survival compared to 3-leaflets aortic valve.
有充分文献记载，每搏量和压力阶差被用于对主动脉瓣狭窄患者进行分型。本研究的目的是评估每搏量和压力阶差对接受主动脉瓣置换术的主动脉瓣狭窄（AS）患者临床结局的影响。方法：共纳入154例连续患者。他们均患有严重主动脉瓣狭窄（主动脉瓣面积[AVA]≤1 cm²，左心室射血分数[LVEF]≥50%），并于2004年1月1日至2010年12月31日期间接受了主动脉瓣置换术（AVR）。收集了临床和超声心动图数据。根据每搏量指数（SVi），定义了低流量（LF，SVi<35 mL/m²）和正常流量（NF，SVi≥35 mL/m²），并根据跨瓣压力阶差，定义了低压力阶差（LG，压力阶差<40 mmHg）和高压力阶差（HG，压力阶差≥40 mmHg）。基于上述分类，将患者分为四组：NF/HG（59例）、NF/LG（30例）、LF/HG（40例）和LF/LG（25例）。为评估二叶式主动脉瓣（BAV）患者与正常三叶式主动脉瓣患者之间的差异，将154例患者分为两组：BAV组和三叶式组。对住院死亡率和总生存率进行随访。通过逻辑回归分析和Cox回归分析评估住院死亡率和总生存率的危险因素。结果：154例患者的平均随访时间为59±32个月，其中NF/HG组的住院死亡率为1.7%，而NF/LG组为6.7%，LF/HG组为12.5%，LF/LG组为10.5%。四组的总生存率分别为NF/HG组72%、NF/LG组92%、LF/HG组55%和LF/LG组84%。BAV组的5年生存率低于三叶式组（78%和93%；P<.05）。住院死亡率的独立相关因素包括心房颤动、同期冠状动脉搭桥术、心脏指数和二叶式主动脉瓣。总生存率的独立因素包括瓣膜-动脉阻抗、体外循环时间、心房颤动、二叶式主动脉瓣和同期冠状动脉搭桥术。结论：LF/LG组的住院结局比NF/HG组和NF/LG组差，但与LF/HG组相似。就总体结局而言，LF/LG组优于NF/HG组和LF/HG组，但比NF/LG组差。与三叶式主动脉瓣患者相比，BAV患者的生存率较差。
