Durand Michel, Machuron Caroline, Guillet Laura, Moury Pierre-Henri, Martin Cécile, Payen Jean-François, Chavanon Olivier, Albaladejo Pierre
Pôle Anesthésie-Réanimation, Hopital Michallon, CHU Grenoble-Alpes, CS 21217, Grenoble Cedex 9, France.
Pôle Cardiovasculaire et Thoracique, Hopital Michallon, CHU Grenoble-Alpes, CS 21217, Grenoble Cedex 9, France.
Heart Surg Forum. 2019 Feb 21;22(1):E057-E062. doi: 10.1532/hsf.2119.
Previous studies have shown that statin use before coronary surgery decreases the mortality and morbidity. This benefit was not clearly detected in isolated valve surgery. The aim of this study was to assess the effect of preoperative statin therapy on postoperative complications and mortality in a large group of patients undergoing valve surgery.
PATIENTS, MATERIALS, AND METHODS: The data of consecutive patients undergoing isolated valve replacement during an 8-year period were retrospectively reviewed from a prospective database. Mortality was compared between the patients who received preoperative statin (statin group [SG]) and those who did not receive statin (control group [CG]) after adjustment on EuroSCORE. Main postoperative complications and mortality were compared between the 2 groups by using a propensity score analysis.
During the study period, 1115 patients were prospectively included, 796 in the CG group and 319 in the SG. The SG patients were significantly older, had more cardiovascular risk factors (hypertension, diabetes, and weight) than the CG patients, and benefited from more elective surgery or aortic valve replacement. No difference in mortality was found between the groups: 4.4% in the SG and 4.5% in the CG, P = .95. Multivariate analysis also revealed no effect of statin on mortality, according to the type of surgery (aortic valve surgery alone or any kind of valve surgery) (P = .93), or the elective or urgent nature of the surgery (P = .67). Statin did not predict mortality after stratification with the EuroSCORE or the Parsonnet score. No difference was found between the 2 groups for postoperative complications (24-hour bleeding, atrial fibrillation, renal failure, length of mechanical ventilation, or hospital stay) and mortality after adjustment with a propensity score.
This study found no difference in mortality or morbidity associated with preoperative statin therapy after isolated valve surgery.
既往研究表明，冠状动脉手术前使用他汀类药物可降低死亡率和发病率。但在单纯瓣膜手术中，这种益处并未得到明确证实。本研究旨在评估术前他汀类药物治疗对大量接受瓣膜手术患者术后并发症和死亡率的影响。
患者、材料与方法：回顾性分析了一个前瞻性数据库中8年间连续接受单纯瓣膜置换术患者的数据。在根据欧洲心脏手术风险评估系统（EuroSCORE）进行调整后，比较接受术前他汀类药物治疗的患者（他汀组[SG]）和未接受他汀类药物治疗的患者（对照组[CG]）的死亡率。采用倾向评分分析比较两组的主要术后并发症和死亡率。
在研究期间，前瞻性纳入了1115例患者，其中CG组796例，SG组319例。SG组患者比CG组患者年龄更大，有更多的心血管危险因素（高血压、糖尿病和体重问题），并且更多地接受了择期手术或主动脉瓣置换术。两组之间的死亡率没有差异：SG组为4.4%，CG组为4.5%，P = 0.95。多因素分析还显示，根据手术类型（单独的主动脉瓣手术或任何类型的瓣膜手术）（P = 0.93）或手术的择期或急诊性质（P = 0.67），他汀类药物对死亡率没有影响。在用EuroSCORE或Parsonnet评分进行分层后，他汀类药物并不能预测死亡率。在调整倾向评分后，两组在术后并发症（24小时出血、房颤、肾衰竭、机械通气时间或住院时间）和死亡率方面没有差异。
本研究发现，单纯瓣膜手术后，术前他汀类药物治疗在死亡率或发病率方面没有差异。
