Cormier B, Luxereau P, Bloch C, Ducimetiere P, Boustani F, Badaoui G, Dybantsa P, Cheung P, Preud'homme G, Acar J
Department of Cardiology, Hôpital Tenon, Paris, France.
Eur Heart J. 1988 Apr;9 Suppl E:113-20. doi: 10.1093/eurheartj/9.suppl_e.113.
A total of 675 patients (mean age 60 +/- 11 years, range 22-85, 71% males) with calcified pure aortic stenosis (490) or mixed lesions (185) had an aortic prosthesis: 290 Starr-Edwards, 147 Bjork, 18 other mechanical valves, 163 pericardial xenografts, 57 porcine xenografts; 76 patients simultaneously underwent a coronary bypass, 12 a replacement of ascending aorta, and six a mitral valvuloplasty. Preoperatively, 67% were in functional class III or IV (NYHA); 69.5% had a coronary arteriography: significant coronary stenosis was observed in 27% of patients. The operative mortality was 6.8% depending on the functional class at surgery, age (4.9% before 70 years, vs. 12.5% after), and the date of surgery (8.1% before 1983 vs. 3.7% after). The 10- and 15-year actuarial survival rates were 62 +/- 3% and 44 +/- 4%, respectively. No significant differences were observed between patients with pure aortic stenosis and mixed aortic lesions. In patients over 70 years, the survival rates were 71 +/- 5% at five years and 51 +/- 10% at 10 years. Age, functional class, degree of congestive heart failure, and degree of cardiomegaly were the main preoperative predictors of late death. At 10 years, 88% of patients were free from myocardial dysfunction, 87% from thromboembolic events, and 89% from haemorrhages. We conclude that in this type of valvulopathy, short- and long-term surgical results are good despite the fact that most patients are elderly and in an advanced functional class.
共有675例患有钙化性单纯主动脉瓣狭窄（490例）或混合性病变（185例）的患者接受了主动脉瓣置换术：290例使用Starr-Edwards瓣膜，147例使用Bjork瓣膜，18例使用其他机械瓣膜，163例使用心包异种移植物，57例使用猪异种移植物；76例患者同时接受了冠状动脉搭桥术，12例接受了升主动脉置换术，6例接受了二尖瓣成形术。术前，67%的患者心功能分级为III级或IV级（纽约心脏协会）；69.5%的患者进行了冠状动脉造影：27%的患者观察到明显的冠状动脉狭窄。手术死亡率为6.8%，取决于手术时的心功能分级、年龄（70岁之前为4.9%，70岁之后为12.5%）以及手术日期（1983年之前为8.1%，之后为3.7%）。10年和15年的精算生存率分别为62±3%和44±4%。单纯主动脉瓣狭窄患者和混合性主动脉病变患者之间未观察到显著差异。70岁以上患者，五年生存率为71±5%，十年生存率为51±10%。年龄、心功能分级、充血性心力衰竭程度和心脏扩大程度是晚期死亡的主要术前预测因素。10年后，88%的患者无心肌功能障碍，87%的患者无血栓栓塞事件，89%的患者无出血。我们得出结论，在这类瓣膜病中，尽管大多数患者年龄较大且心功能分级处于晚期，但短期和长期手术效果良好。
