Scherman Jacques, Manganyi Rodgers, Human Paul, Pennel Timothy, Brooks Andre, Brink Johan, Zilla Peter
Chris Barnard Division of Cardiothoracic Surgery, University of Cape Town, Cape Town, South Africa.
Chris Barnard Division of Cardiothoracic Surgery, University of Cape Town, Cape Town, South Africa.
J Thorac Cardiovasc Surg. 2019 Mar;157(3):886-893. doi: 10.1016/j.jtcvs.2018.06.083. Epub 2018 Jul 20.
Although the results of aortic valve replacement are well documented for industrialized countries, the outcome in patients with rheumatic aortic valve disease in low- to middle-income countries is less well explored. The aim of this study was to determine the long-term survival and clinical outcomes after isolated aortic valve replacement in patients with rheumatic heart disease in a Sub-Saharan country where follow-up of indigent patients is often challenging.
A retrospective review of 969 aortic valve replacements performed between 2003 and 2013 was conducted at Cape Town's Groote Schuur Hospital. Patients who underwent concomitant procedures (n = 664) or had nonrheumatic valve pathology (n = 185) were excluded. The mean age of the rheumatic cohort (n = 121) was 43.1 ± 11.6 years with a mean follow-up period of 6.14 ± 3.44 years. The primary end points were survival and valve-related complications.
A 15% cardiac- or valve-related 10-year mortality after receiving a mechanical prosthesis corresponded with a significantly higher mortality rate than that of a matched population. Overall cumulative survival at 1, 5, and 10 years was 93.5% (87.0-96.9), 86.4% (78.4-91.8), and 78.1% (67.5-86.0), respectively, and the corresponding cumulative freedom from combined thromboembolism and bleeding was 94.4% (88.2-97.5), 87.4% (79.4-92.5), and 86.1% (77.9-91.6), respectively.
In low- to middle-income countries, with their unique mix of indigent and "First World" patients, rheumatic heart disease still accounts for a significant proportion of patients requiring isolated aortic valve replacement. Although mechanical prostheses are often selected in these young adults, survival remains suboptimal. Major bleeding and thromboembolic events account for the majority (77%) of the reported valve-related complications.
尽管工业化国家主动脉瓣置换术的结果已有充分记录，但中低收入国家风湿性主动脉瓣疾病患者的治疗结果研究较少。本研究的目的是确定在撒哈拉以南一个国家，对贫困患者随访往往具有挑战性的情况下，风湿性心脏病患者单纯主动脉瓣置换术后的长期生存率和临床结局。
对2003年至2013年间在开普敦格罗特舒尔医院进行的969例主动脉瓣置换术进行回顾性研究。排除同期进行其他手术的患者（n = 664）或患有非风湿性瓣膜病变的患者（n = 185）。风湿性队列患者（n = 121）的平均年龄为43.1±11.6岁，平均随访期为6.14±3.44年。主要终点是生存率和瓣膜相关并发症。
接受机械瓣膜置换术后10年心脏或瓣膜相关死亡率为15%，与匹配人群相比，死亡率显著更高。1年、5年和10年的总体累积生存率分别为93.5%（87.0 - 96.9）、86.4%（78.4 - 91.8）和78.1%（67.5 - 86.0），相应的血栓栓塞和出血合并症的累积无事件生存率分别为94.4%（88.2 - 97.5）、87.4%（79.4 - 92.5）和86.1%（77.9 - 91.6）。
在中低收入国家，贫困患者和“第一世界”患者并存，风湿性心脏病在单纯主动脉瓣置换术患者中仍占相当比例。尽管这些年轻患者常选择机械瓣膜，但生存率仍不理想。报告的瓣膜相关并发症中，大出血和血栓栓塞事件占多数（77%）。
