Safian R D, Berman A D, Diver D J, McKay L L, Come P C, Riley M F, Warren S E, Cunningham M J, Wyman R M, Weinstein J S
Cardiovascular Division, Beth Israel Hospital, Boston, MA 02215.
N Engl J Med. 1988 Jul 21;319(3):125-30. doi: 10.1056/NEJM198807213190301.
Between October 1, 1985, and April 1, 1988, we performed balloon aortic valvuloplasty in 170 patients (mean age [+/- SD], 77 +/- 5 years) who had symptomatic aortic stenosis. The procedure was completed successfully in 168 patients and resulted in significant increases in the mean (+/- SD) aortic-valve area (from 0.6 +/- 0.2 to 0.9 +/- 0.3 cm2) and cardiac output (from 4.6 +/- 3.4 to 4.8 +/- 1.4 liters per minute) and decreases in the peak aortic-valve pressure gradient (from 71 +/- 20 to 36 +/- 14 mm Hg) (P less than 0.01 for all three comparisons). There were six in-hospital deaths, and five patients required early aortic-valve replacement. Follow-up data were available for all patients, for a period averaging 9.1 months. In addition to the 6 patients who died in the hospital, 25 patients died an average of 6.4 +/- 5.3 months after discharge. Symptoms recurred in 44 patients; they were managed by repeat valvuloplasty in 16 patients, by aortic-valve replacement in 17, and by medical therapy in 11. At the most recent follow-up examination, the symptoms of 103 patients had improved after valvuloplasty; this number includes 15 patients with restenosis who successfully underwent redilation. Life-table analysis indicates that the probability of survival 12 months after the procedure was 74 percent. We conclude that balloon aortic valvuloplasty is an effective palliative therapy for some elderly patients with symptomatic aortic stenosis. Symptoms improve in the majority of patients; although restenosis is common, it can be managed in some patients by repeat balloon dilation.
1985年10月1日至1988年4月1日期间，我们对170例有症状的主动脉瓣狭窄患者实施了球囊主动脉瓣成形术（平均年龄[±标准差]，77±5岁）。168例患者手术成功完成，术后平均（±标准差）主动脉瓣面积显著增加（从0.6±0.2增加至0.9±0.3 cm²），心输出量增加（从4.6±3.4增加至4.8±1.4升/分钟），主动脉瓣峰值压力阶差降低（从71±20降至36±14 mmHg）（三项比较P均<0.01）。住院期间死亡6例，5例患者需要早期主动脉瓣置换。所有患者均有随访数据，平均随访时间为9.1个月。除6例在医院死亡的患者外，25例患者出院后平均6.4±5.3个月死亡。44例患者症状复发；其中16例通过再次瓣膜成形术治疗，17例通过主动脉瓣置换治疗，11例通过药物治疗。在最近一次随访检查时，103例患者瓣膜成形术后症状改善；这其中包括15例再狭窄患者成功接受了再次扩张治疗。寿命表分析表明，术后12个月的生存率为74%。我们得出结论，球囊主动脉瓣成形术是治疗某些有症状的老年主动脉瓣狭窄患者的一种有效的姑息治疗方法。大多数患者症状改善；尽管再狭窄很常见，但部分患者可通过再次球囊扩张进行处理。
