Department of Cardiology and Department of Cardiothoracic Surgery, Institut Jantung Negara, 145, Jalan Tun Razak, 50400, Kuala Lumpur, Malaysia.
J Cardiothorac Surg. 2024 Jan 2;19(1):3. doi: 10.1186/s13019-023-02472-2.
This study examined the characteristics and outcomes of surgical aortic valve replacement (SAVR) both isolated and in combination with other cardiac surgery in Malaysia from 2015 to 2021.
This was a retrospective study of 1346 patients analyzed on the basis of medical records, echocardiograms and surgical reports. The overall sample was both considered as a whole and divided into aortic stenosis (AS)/aortic regurgitation (AR)-predominant and similar-severity subgroups.
The most common diagnosis was severe AS (34.6%), with the 3 most common etiologies being bicuspid valve degeneration (45.3%), trileaflet valve degeneration (36.3%) and rheumatic valve disease (12.2%). The second most common diagnosis was severe AR (25.5%), with the most common etiologies being root dilatation (21.0%), infective endocarditis (IE) (16.6%) and fused prolapse (12.2%). Rheumatic valve disease was the most common mixed disease. A total of 54.5% had AS-predominant pathology (3 most common etiologies: bicuspid valve degeneration valve, degenerative trileaflet valve and rheumatic valve disease), 36.9% had AR-predominant pathology (top etiologies: root dilatation, rheumatic valve disease and IE), and 8.6% had similar severity of AS and AR. Overall, 62.9% of patients had trileaflet valve morphology, 33.3% bicuspid, 0.6% unicuspid and 0.3% quadricuspid. For AS, the majority were high-gradient severe AS (49.9%), followed by normal-flow low-gradient (LG) severe AS (10.0%), paradoxical low-flow (LF)-LG severe AS (6.4%) and classical LF-LG severe AS (6.1%). The overall in-hospital and total 1-year mortality rates were 6.4% and 14.8%, respectively. Pure severe AS had the highest mortality. For AS-predominant pathology, the etiology with the highest mortality was trileaflet valve degeneration; for AR-predominant pathology, it was dissection. The overall survival probability at 5 years was 79.5% in all patients, 75.7% in the AS-predominant subgroup, 83.3% in the AR-predominant subgroup, and 87.3% in the similar-severity subgroup.
The 3 most common causes of AS- predominant patients undergoing SAVR is bicuspid valve degeneration, degenerative trileaflet valve and rheumatic and for AR-predominant is root dilatation, rheumatic and IE. Rheumatic valve disease is an important etiology in our SAVR patients especially in mixed aortic valve disease. Study registration IJNREC/562/2022.
本研究旨在探讨 2015 年至 2021 年期间在马来西亚进行的单纯主动脉瓣置换术（SAVR）和联合其他心脏手术的特点和结果。
这是一项回顾性研究，共纳入了 1346 名患者，研究依据病历、超声心动图和手术报告进行。整体样本既作为一个整体进行考虑，也分为主动脉瓣狭窄（AS）/主动脉瓣反流（AR）为主型和相似严重程度亚组进行分析。
最常见的诊断是严重 AS（34.6%），最常见的三种病因是二叶瓣退化（45.3%）、三叶瓣退化（36.3%）和风湿性瓣膜病（12.2%）。其次最常见的诊断是严重 AR（25.5%），最常见的病因是根部扩张（21.0%）、感染性心内膜炎（IE）（16.6%）和融合脱垂（12.2%）。风湿性瓣膜病是最常见的混合性疾病。共有 54.5%的患者存在 AS 为主型病变（三种最常见的病因：二叶瓣退化、退行性三叶瓣和风湿性瓣膜病），36.9%的患者存在 AR 为主型病变（三种最常见的病因：根部扩张、风湿性瓣膜病和 IE），8.6%的患者 AS 和 AR 的严重程度相似。总体而言，62.9%的患者为三叶瓣形态，33.3%为二叶瓣，0.6%为单叶瓣，0.3%为四叶瓣。对于 AS，大多数为高梯度重度 AS（49.9%），其次是正常流量低梯度（LG）重度 AS（10.0%）、反常低流量（LF）-LG 重度 AS（6.4%）和经典 LF-LG 重度 AS（6.1%）。总的院内和 1 年死亡率分别为 6.4%和 14.8%。单纯重度 AS 的死亡率最高。对于 AS 为主型病变，死亡率最高的病因是三叶瓣退化；对于 AR 为主型病变，死亡率最高的病因是夹层。所有患者的 5 年总生存率为 79.5%，AS 为主型亚组为 75.7%，AR 为主型亚组为 83.3%，相似严重程度亚组为 87.3%。
行 SAVR 的 AS 为主型患者的三个最常见病因是二叶瓣退化、退行性三叶瓣和风湿性，而 AR 为主型患者的三个最常见病因是根部扩张、风湿性和 IE。风湿性瓣膜病是我们 SAVR 患者的一个重要病因，特别是在主动脉瓣混合性疾病中。研究注册 IJNREC/562/2022。
