Department of Cardiac Surgery, Mayo Clinic, Rochester, Minn.
Department of Cardiac Surgery, Mayo Clinic, Rochester, Minn.
J Thorac Cardiovasc Surg. 2018 Jul;156(1):98-103. doi: 10.1016/j.jtcvs.2017.12.048. Epub 2017 Dec 19.
Outcome data on aortic valve replacement in patients with amyloidosis are limited. To address this issue, we reviewed our experience of patients with amyloidosis who underwent aortic valve replacement.
We retrospectively reviewed the records of 16 patients with amyloidosis who underwent aortic valve replacement between May 2000 and February 2017.
The cohort comprised 11 males (69%) and 5 females (31%). The median patient age was 76 years (interquartile range [IQR], 71-82 years), and Society of Thoracic Surgeons predicted rate of mortality was 5.0% (IQR, 2.4%-8.7%). Amyloidosis type was immunoglobulin light chain in 6 patients (38%), age-related in 6 (38%), and localized in 4 (25%). The operation was surgical aortic valve replacement in 11 patients (69%) and balloon-expandable transfemoral transcatheter aortic valve insertion in the other 5. There was no procedure-related stroke, need for new-onset dialysis or pacemaker, or death within 30 days of surgery. The median length of hospital stay was 1 day (IQR, 1-2 days) in the transcatheter valve insertion group and 6 days (IQR, 6-8 days) in the surgical group (P = .002). Follow-up was available for all patients at a median of 1.9 years (IQR, 1.2-4.8 years). During the follow-up period, there were 4 deaths, all occurring >1 year after surgery.
Aortic valve replacement can be performed with low risk of operative morbidity and mortality in patients with amyloidosis. Transcatheter valve insertion has the advantage of reduced hospital length of stay. The 1-year survival is excellent.
关于淀粉样变性患者行主动脉瓣置换术的预后数据有限。为解决这一问题，我们回顾了我院淀粉样变性患者行主动脉瓣置换术的经验。
我们回顾性分析了 2000 年 5 月至 2017 年 2 月期间 16 例行主动脉瓣置换术的淀粉样变性患者的病历资料。
该队列包括 11 名男性（69%）和 5 名女性（31%）。患者中位年龄为 76 岁（四分位间距 [IQR]，71-82 岁），胸外科医师协会死亡率预测率为 5.0%（IQR，2.4%-8.7%）。淀粉样变性类型为免疫球蛋白轻链型 6 例（38%），年龄相关性 6 例（38%），局限性 4 例（25%）。手术方式为 11 例（69%）外科主动脉瓣置换术，5 例（31%）经股动脉球囊扩张式经导管主动脉瓣插入术。手术过程中无相关卒中、新发透析或起搏器需求，也无术后 30 天内死亡。经导管瓣膜插入组中位住院时间为 1 天（IQR，1-2 天），外科组为 6 天（IQR，6-8 天）（P=0.002）。所有患者中位随访时间为 1.9 年（IQR，1.2-4.8 年）。随访期间，4 例患者死亡，均发生在术后 1 年以上。
对于淀粉样变性患者，行主动脉瓣置换术的手术发病率和死亡率较低。经导管瓣膜插入术的优势在于住院时间缩短。1 年生存率很高。
