Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Am J Cardiol. 2019 Apr 15;123(8):1321-1328. doi: 10.1016/j.amjcard.2019.01.035. Epub 2019 Jan 25.
Aortic valve (AV) replacement (AVR) is the only effective treatment for severe aortic stenosis (AS). However, survival benefits by performing AVR in asymptomatic AS patients with preserved left ventricular (LV) function remains controversial. This study included 468 patients (aged 64.2 ± 13.0 years, 232 women) with preserved LV function (≥50%) and severe AS (AV area ≤1.0 cm, peak trans-AV velocity [V] ≥4.0 m/s, or mean AV pressure gradient ≥40 mm Hg) between 2000 and 2015. AVR was performed in 221 (47.2%) patients early (within 3 months; n = 130, 27.8%) or during follow-up (n = 91, 19.4%), whereas the remainder (n = 247) received medical treatment. Time-dependent Cox regression analyses were performed to determine the impact of AVR on long-term survival outcomes. During a median follow-up of 60.9 months (quartile 1 to 3, 29.9 to 107.0 months), 72 (15.4%) patients developed AS-related symptoms and 146 (31.2%) died. On time-dependent Cox models, AVR was associated with a significant risk reduction in all-cause death (hazard ratio [HR], 0.62; 95% confidence interval [CI], 0.40 to 0.97; p = 0.036) and cardiac death (HR, 0.59; 95% CI, 0.35 to 0.995; p = 0.048) after adjusting for significant contributors to mortality. Survival benefits by performing AVR were manifested in most risk subgroups. In conclusion, AVR in asymptomatic severe AS patients with preserved LV function resulted in significant survival benefits, suggesting that early recruitment for AVR may be warranted before ventricular dysfunction or symptom development.
主动脉瓣（AV）置换（AVR）是治疗严重主动脉瓣狭窄（AS）的唯一有效方法。然而，对于左心室（LV）功能正常的无症状 AS 患者进行 AVR 的生存获益仍存在争议。本研究纳入了 2000 年至 2015 年间 468 例 LV 功能正常（≥50%）和严重 AS（AV 面积≤1.0cm，峰值跨 AV 速度[V]≥4.0m/s，或平均 AV 压力梯度≥40mmHg）的患者。其中 221 例（47.2%）患者早期（3 个月内；n=130，27.8%）或在随访期间（n=91，19.4%）进行了 AVR，其余 247 例患者接受了药物治疗。进行了时间依赖性 Cox 回归分析以确定 AVR 对长期生存结果的影响。在中位随访 60.9 个月（四分位 1 至 3，29.9 至 107.0 个月）期间，72 例（15.4%）患者出现 AS 相关症状，146 例（31.2%）死亡。在时间依赖性 Cox 模型中，AVR 与全因死亡风险显著降低相关（风险比[HR]，0.62；95%置信区间[CI]，0.40 至 0.97；p=0.036）和心脏死亡（HR，0.59；95%CI，0.35 至 0.995；p=0.048），调整了对死亡率有显著影响的因素后。在大多数风险亚组中，AVR 可带来生存获益。结论：对于 LV 功能正常的无症状严重 AS 患者，行 AVR 可显著提高生存率，这表明在心室功能障碍或出现症状之前，可能需要早期招募患者进行 AVR。
