Shvartz Vladimir, Sokolskaya Maria, Petrosyan Andrey, Ispiryan Artak, Donakanyan Sergey, Bockeria Leo, Bockeria Olga
Department of Surgical Treatment for Interactive Pathology, Bakoulev Scientific Center for Cardiovascular Surgery, Rublevskoe Shosse, 135, 121552 Moscow, Russia.
Pathophysiology. 2022 Mar 9;29(1):106-117. doi: 10.3390/pathophysiology29010010.
Background: Understanding of the risk factors for the development of adverse outcomes after aortic valve replacement is necessary to develop timely preventive measures and to improve the results of surgical treatment. Methods: We analyzed patients with aortic stenosis (n = 742) who underwent surgical treatment in the period 2014−2020. The average age was 63 (57;69) years—men 58%, women 42%. Results: The hospital mortality rate was 3% (22 patients). The following statistically significant threshold values (cut-off points) were obtained in the ROC analysis: aortic cross-clamp time > 93 min AUC (CI) 0.676 (0.640−0.710), p = 0.010; cardiopulmonary bypass time > 144 min AUC (CI) 0.809 (0.778−0.837), p < 0.0001, hemoglobin before op <120 g/L. AUC (CI) 0.762 (0.728−0.793), p < 0.0001, hematocrit before op <39% AUC (CI) 0.755 (0.721−0.786), p < 0.001, end-diastolic dimension index >2.39 AUC (CI) 0.647 (0.607−0.686), p = 0.014, end-systolic dimension index > 1.68 AUC (CI) 0.657 (0.617−0.695), p = 0.009. Statistically significant independent predictors of hospital mortality were identified: BMI > 30 kg/m2 (OR 2.84; CI 1.15−7.01), ischemic heart disease (OR 3.65; CI 1.01−13.2), diabetes (OR 3.88; CI 1.38−10.9), frequent ventricular ectopy before operation (OR 9.78; CI 1.91−50.2), mitral valve repair (OR 4.47; CI 1.76−11.3), tricuspid valve repair (OR 3.06; CI 1.09−8.58), 3 and more procedures (OR 4.44; CI 1.67−11.8). Conclusions: The hospital mortality rate was 3%. The main indicators associated with the risk of death were: diabetes, overweight (body mass index more than 30 kg/m2), frequent ventricular ectopy before surgery, hemoglobin level below 120 g/L, hematocrit level below 39%, longer cardiopulmonary bypass time and aortic cross-clamp time, additional mitral and tricuspid valve interventions.
了解主动脉瓣置换术后不良结局发生的风险因素对于制定及时的预防措施和改善手术治疗效果至关重要。方法：我们分析了2014 - 2020年期间接受手术治疗的主动脉瓣狭窄患者（n = 742）。平均年龄为63（57；69）岁，男性占58%，女性占42%。结果：医院死亡率为3%（22例患者）。在ROC分析中获得了以下具有统计学意义的阈值（截断点）：主动脉阻断时间> 93分钟，AUC（CI）0.676（0.640 - 0.710），p = 0.010；体外循环时间> 144分钟，AUC（CI）0.809（0.778 - 0.837），p < 0.0001，术前血红蛋白<120 g/L，AUC（CI）0.762（0.728 - 0.793），p < 0.0001，术前血细胞比容<39%，AUC（CI）0.755（0.721 - 0.786），p < 0.001，舒张末期内径指数>2.39，AUC（CI）0.647（0.607 - 0.686），p = 0.014，收缩末期内径指数> 1.68，AUC（CI）0.657（0.617 - 0.695），p = 0.009。确定了具有统计学意义的医院死亡率独立预测因素：BMI> 30 kg/m²（OR 2.84；CI 1.15 - 7.01），缺血性心脏病（OR 3.65；CI 1.01 - 13.2），糖尿病（OR 3.88；CI 1.38 - 10.9），术前频发室性早搏（OR 9.78；CI 1.91 - 50.2），二尖瓣修复（OR 4.47；CI 1.76 - 11.3），三尖瓣修复（OR 3.06；CI 1.09 - 8.58），3项及以上手术（OR 4.44；CI 1.67 - 11.8）。结论：医院死亡率为3%。与死亡风险相关的主要指标为：糖尿病、超重（体重指数超过30 kg/m²）、术前频发室性早搏、血红蛋白水平低于120 g/L、血细胞比容水平低于39%、体外循环时间和主动脉阻断时间较长、二尖瓣和三尖瓣额外干预。
