主动脉生物瓣置换术后的长期结果。

Long-Term Outcomes Following Surgical Aortic Bioprosthesis Implantation.

机构信息

Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.

出版信息

J Am Coll Cardiol. 2018 Apr 3;71(13):1401-1412. doi: 10.1016/j.jacc.2018.01.059.

DOI:10.1016/j.jacc.2018.01.059

PMID:29598859

Abstract

BACKGROUND

Few data exist on long-term outcomes and structural valve degeneration (SVD) in consecutive unselected patients undergoing surgical aortic valve replacement (SAVR).

OBJECTIVES

The goal of this study was to determine the long-term outcomes of a contemporary cohort of consecutive unselected SAVR recipients with a focus on evaluating clinical outcomes and SVD based on echocardiographic criteria.

METHODS

A total of 672 consecutive patients (mean age: 72 ± 8 years; 61.5% male) undergoing SAVR with a bioprosthesis between 2002 and 2004 were included. Baseline and follow-up data were prospectively collected in a dedicated database. Baseline post-operative echocardiographic data were obtained in the 624 patients alive at hospital discharge and in 209 patients at 10 years (87% of the patients at risk). SVD was defined as subclinical (increase >10 mm Hg in mean transvalvular gradient + decrease >0.3 cm in valve area and/or new-onset mild or moderate aortic regurgitation) and clinically relevant (increase >20 mm Hg in mean transvalvular gradient + decrease >0.6 cm in valve area and/or new-onset moderate-to-severe aortic regurgitation).

RESULTS

At a median follow-up of 10 years (interquartile range: 5 to 13 years), 432 patients (64.3%) had died. Older age, left ventricular dysfunction, atrial fibrillation, chronic obstructive pulmonary disease, greater body mass index, and diabetes mellitus were associated with an increased mortality risk (p < 0.05 for all). Clinically relevant SVD occurred in 6.6% of patients; 30.1% of patients had subclinical SVD. A greater body mass index and the use of a specific aortic bioprosthesis were independently associated with clinically relevant SVD (p < 0.05 for both), and 83% of these patients underwent aortic valve reintervention (valve-in-valve transcatheter aortic valve replacement in 44% of them).

CONCLUSIONS

The 10-year mortality rate in elderly SAVR recipients of a bioprosthetic valve was considerable, chiefly determined by their older age and the presence of comorbidities. Clinically relevant SVD was infrequent, but close to one third of the population exhibited subclinical SVD. These results provide contemporary data on long-term clinical outcomes and SVD post-SAVR, and they should be taken into consideration when evaluating late clinical outcomes and valve durability after transcatheter aortic valve replacement.

摘要

背景

目前关于连续入选的接受外科主动脉瓣置换术（SAVR）的患者的长期结果和结构性瓣膜退化（SVD）的数据很少。

目的

本研究的目的是确定连续入选的接受 SAVR 的当代患者队列的长期结果，重点是根据超声心动图标准评估临床结果和 SVD。

方法

共纳入 672 例连续患者（平均年龄：72 ± 8 岁；61.5%为男性），于 2002 年至 2004 年间接受生物瓣 SAVR。在专用数据库中前瞻性收集基线和随访数据。624 例在出院时存活的患者和 209 例在 10 年时（风险患者的 87%）获得了基线术后超声心动图数据。SVD 定义为亚临床（跨瓣平均梯度增加>10mmHg+瓣面积减少>0.3cm 和/或新发轻度或中度主动脉瓣反流）和临床相关（跨瓣平均梯度增加>20mmHg+瓣面积减少>0.6cm 和/或新发中度至重度主动脉瓣反流）。

结果

中位随访 10 年（四分位距：5 至 13 年），432 例患者（64.3%）死亡。年龄较大、左心室功能障碍、心房颤动、慢性阻塞性肺疾病、更大的体重指数和糖尿病与死亡率增加相关（所有 p<0.05）。6.6%的患者发生临床相关 SVD；30.1%的患者发生亚临床 SVD。更大的体重指数和特定的主动脉生物瓣的使用与临床相关 SVD 独立相关（两者均为 p<0.05），其中 83%的患者接受了主动脉瓣再介入治疗（其中 44%的患者接受了瓣中瓣经导管主动脉瓣置换术）。