保留瓣膜的主动脉根部置换术——中期结果与生活质量
Valve-sparing aortic root replacement-midterm outcomes and quality of life.
作者信息
Bori Bata Abdel-Kémal, D'Ostrevy Nicolas, Pereira Bruno, Geoffroy Etienne, Dauphin Nicolas, Eljezi Vedat, Azarnoush Kasra, Ulman Lucie, Camilleri Lionel
机构信息
Heart Surgery Department, Clinical Research and Innovation Direction, Gabriel Montpied University Hospital, Clermont-Ferrand, France.
Biostatistic's Unit, Clinical Research and Innovation Direction, Gabriel Montpied University Hospital, Clermont-Ferrand, France.
出版信息
Cardiovasc Diagn Ther. 2017 Dec;7(6):572-580. doi: 10.21037/cdt.2017.08.02.
BACKGROUND
This study evaluated the midterm outcomes, the valve related events and quality of life of patients treated by valve-sparing aortic root replacement (VSRR).
METHODS
From January 2003 to December 2014, 88 consecutive patients diagnosed with an aortic root aneurysm or ascending aortic aneurysms underwent VSRR surgery. The mean age was 55±14 (range 19-77) years. A total of 84% of the patients were male; 89% were in New York Heart Association functional class I or II, 55% had aortic regurgitation (AR) grade III or IV. Twenty-four patients (27.3%) had bicuspid aortic valve. The mean left ventricular ejection fraction (LVEF) was 61%±9% (range 29-78%). Patients were yearly followed by family doctors and referent cardiologists. Doppler echocardiographic examinations were obtained annually in all patients. The midterm clinical, echocardiographic results and quality of life were analyzed. The mean follow-up was 5.3±3 (range 1-12) years.
RESULTS
Hospital mortality was 1%. There were 10 late deaths (11%) including 5 cardiac cases. Two patients (2%) required an aortic valve or graft prosthesis reoperation. Aortic valve endocarditis occurred in two patients. Thromboembolic events were reported in three patients. None of the following morbidity has been observed: structural valve deterioration, nonstructural dysfunction, valve thrombosis, bleeding event. The 5- and 8-year survival were 92% and 88%, respectively. The 8-year survival free from cardiac death was 88%. The mean of EuroQoL visual analogue scale (EQ VAS) and EQ index were respectively 83±15 (range 30-100) and 0.94±0.12 (range 0.5-1).
CONCLUSIONS
Eight-year clinical improvement, function of the spared aortic valve and quality of life after valve sparing aortic root surgery appear excellent.
背景
本研究评估了保留瓣膜主动脉根部置换术（VSRR）治疗患者的中期结果、瓣膜相关事件及生活质量。
方法
2003年1月至2014年12月，88例连续诊断为主动脉根部瘤或升主动脉瘤的患者接受了VSRR手术。平均年龄为55±14（范围19 - 77）岁。84%的患者为男性；89%处于纽约心脏协会心功能I或II级，55%有III或IV级主动脉瓣反流（AR）。24例患者（27.3%）有二叶式主动脉瓣。平均左心室射血分数（LVEF）为61%±9%（范围29 - 78%）。患者由家庭医生和专科心脏病专家每年进行随访。所有患者每年进行多普勒超声心动图检查。分析中期临床、超声心动图结果及生活质量。平均随访时间为5.3±3（范围1 - 12）年。
结果
医院死亡率为1%。有10例晚期死亡（11%），其中5例为心脏相关病例。2例患者（2%）需要再次进行主动脉瓣或人工血管置换手术。2例患者发生主动脉瓣心内膜炎。3例患者报告有血栓栓塞事件。未观察到以下任何并发症：结构性瓣膜退变、非结构性功能障碍、瓣膜血栓形成、出血事件。5年和8年生存率分别为92%和88%。8年无心脏死亡生存率为88%。欧洲生活质量视觉模拟量表（EQ VAS）均值和EQ指数分别为83±15（范围30 - 100）和0.94±0.12（范围0.5 - 1）。
结论
保留瓣膜主动脉根部手术后8年的临床改善、保留主动脉瓣功能及生活质量似乎都非常好。
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