Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
Mayo Clin Proc. 2020 Apr;95(4):727-737. doi: 10.1016/j.mayocp.2019.10.038.
To compare the incidence of major adverse cardiac events and death among severe aortic stenosis patients with and without aortic valve replacement (AVR) before noncardiac surgery.
We retrospectively evaluated 491 severe aortic stenosis patients undergoing non-emergency/non-urgent elevated-risk noncardiac surgery between January 1, 2000, and December 31, 2013, including 203 patients (mean age, 74±10 years, 63.5% men) with previous AVR and 288 patients (mean age, 77±12 years, 55.6% men) without prior AVR.
The incidence of major adverse cardiac events was significantly lower in the AVR group (5.4% vs 20.5%; P<.001), primarily because of the lower incidence of new or worsening heart failure (2.5% vs 17.7%; P<.001), compared with the non-AVR group. No significant differences were observed between the groups with and without AVR in the incidence of death (2.5% vs 3.5%; P=.56), myocardial infarction (0.5% vs 1.4%; P=.48), ventricular arrhythmia (0.0% vs 0.7%; P=.51), or stroke (0.0% vs 0.7%; P=.51) at 30-days. At a median follow-up of 4.2 (interquartile range,1.3-7.5) years, overall mortality was significantly worse in patients without versus with AVR (5-year rate: 57.0% vs 32.7%; P<.001). Symptomatic patients without AVR (n=35) had the worst outcomes overall, including increased 30-day and overall mortality rates, compared with the AVR-group and asymptomatic non-AVR patients.
In patients with severe aortic stenosis, AVR before noncardiac surgery was associated with decreased incidence of heart failure after noncardiac surgery and improved overall survival without differences in 30-day survival, myocardial infarction, ventricular arrhythmia, or stroke. Preoperative AVR should be considered in symptomatic patients for whom the benefit of AVR is greatest.
比较主动脉瓣置换术（AVR）前后严重主动脉瓣狭窄患者非心脏手术期间主要不良心脏事件和死亡的发生率。
我们回顾性评估了 2000 年 1 月 1 日至 2013 年 12 月 31 日期间接受非紧急/非紧急高危非心脏手术的 491 例严重主动脉瓣狭窄患者，其中 203 例（平均年龄 74±10 岁，63.5%为男性）有 AVR 病史，288 例（平均年龄 77±12 岁，55.6%为男性）无 AVR 病史。
AVR 组的主要不良心脏事件发生率显著降低（5.4% vs 20.5%；P<.001），主要是由于新发生或恶化的心力衰竭发生率较低（2.5% vs 17.7%；P<.001），与非 AVR 组相比。在有和没有 AVR 的组之间，30 天的死亡率（2.5% vs 3.5%；P=.56）、心肌梗死（0.5% vs 1.4%；P=.48）、室性心律失常（0.0% vs 0.7%；P=.51）或卒中（0.0% vs 0.7%；P=.51）无显著差异。在中位随访 4.2（四分位距，1.3-7.5）年后，无 AVR 患者的总死亡率明显高于有 AVR 患者（5 年率：57.0% vs 32.7%；P<.001）。无症状无 AVR 患者（n=35）的总体预后最差，包括 30 天和总死亡率增加，与 AVR 组和无症状非 AVR 患者相比。
在严重主动脉瓣狭窄患者中，非心脏手术前的 AVR 与非心脏手术后心力衰竭发生率降低和整体生存率提高相关，30 天生存率、心肌梗死、室性心律失常或卒中无差异。对于 AVR 获益最大的有症状患者，应考虑术前 AVR。
