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外科主动脉瓣置换术对动脉僵硬度的影响:瓣膜类型有影响吗?

The Effect of Surgical Aortic Valve Replacement on Arterial Stiffness: Does the Valve Type Matter?

作者信息

Sigala Evangelia, Terentes-Printzios Dimitrios, Gardikioti Vasiliki, Baikoussis Nikolaos G, Koumallos Nikolaos, Katsaros Andreas, Lozos Vasileios, Kouerinis Ilias, Triantafillou Konstantinos, Filis Konstantinos, Tsioufis Konstantinos, Vlachopoulos Charalambos

机构信息

First Department of Cardiology, Hippokration Hospital, 11527 Athens, Greece.

Department of Cardiology, Tzaneio General Hospital, 18536 Piraeus, Greece.

出版信息

J Pers Med. 2024 May 11;14(5):509. doi: 10.3390/jpm14050509.

Abstract

Despite the increasing use of transcatheter aortic valve procedures, many patients still require surgical aortic valve replacement (SAVR). Assessing arterial properties in patients undergoing SAVR for aortic valve stenosis can be challenging, and the existing evidence is inconclusive. Our study aimed to investigate the impact of SAVR on vascular stiffness and the quality of life, as well as the different effects of valve type on arterial properties. We included 60 patients (mean age 70.25 ± 8.76 years, 65% men) with severe symptomatic aortic stenosis who underwent SAVR. Arterial stiffness (cfPWV, baPWV) and vascular parameters (AIx@75, central pressures, SEVR) were measured at baseline, pre-discharge, and 1-year post-operation. The QOL was assessed using the generic questionnaire-short-form health survey 36 (SF-36) pre-operatively and at 1 year. Post-SAVR, cfPWV increased immediately (7.67 ± 1.70 m/s vs. 8.27 ± 1.92 m/s, = 0.009) and persisted at 1 year (8.27 ± 1.92 m/s vs. 9.29 ± 2.59 m/s, ≤ 0.001). Similarly, baPWV (n = 55) increased acutely (1633 ± 429 cm/s vs. 2014 ± 606 cm/s, < 0.001) and remained elevated at 1 year (1633 ± 429 cm/s vs. 1867 ± 408 cm/s, < 0.001). Acute decrease in Alx@75 (31.16 ± 10% vs. 22.48 ± 13%, < 0.001) reversed at 1 year (31.16 ± 10% vs. 30.98 ± 9%, = 0.71). SEVR improved (136.1 ± 30.4% vs. 149.2 ± 32.7%, = 0.01) and persisted at 1 year (136.1 ± 30.4% vs. 147.5 ± 30.4%, = 0.01). SV had a greater cfPWV increase at 1 year ( = 0.049). The QOL improved irrespective of arterial stiffness changes. After SAVR, arterial stiffness demonstrates a persistent increase at 1-year, with valve type having a slight influence on the outcomes. These findings remain consistent despite the perceived QOL.

摘要

尽管经导管主动脉瓣手术的应用日益增多,但许多患者仍需要进行外科主动脉瓣置换术(SAVR)。评估因主动脉瓣狭窄而接受SAVR的患者的动脉特性具有挑战性,现有证据尚无定论。我们的研究旨在调查SAVR对血管僵硬度和生活质量的影响,以及瓣膜类型对动脉特性的不同影响。我们纳入了60例因严重症状性主动脉瓣狭窄而接受SAVR的患者(平均年龄70.25±8.76岁,65%为男性)。在基线、出院前和术后1年测量动脉僵硬度(cfPWV、baPWV)和血管参数(AIx@75、中心压力、SEVR)。术前和术后1年使用通用问卷简版健康调查36(SF-36)评估生活质量。SAVR术后,cfPWV立即升高(7.67±1.70米/秒对8.27±1.92米/秒,P = 0.009),并在1年时持续升高(8.27±1.92米/秒对9.29±2.59米/秒,P≤0.001)。同样,baPWV(n = 55)急剧升高(1633±429厘米/秒对2014±606厘米/秒,P<0.001),并在1年时保持升高(1633±429厘米/秒对1867±408厘米/秒,P<0.001)。AIx@75急性下降(31.16±10%对22.48±13%,P<0.001)在1年时逆转(31.16±10%对30.98±9%,P = 0.71)。SEVR有所改善(136.1±30.4%对149.2±32.7%,P = 0.01),并在1年时持续改善(136.1±30.4%对147.5±30.4%,P = 0.01)。生物瓣膜组在1年时cfPWV升高幅度更大(P = 0.049)。生活质量的改善与动脉僵硬度变化无关。SAVR术后,动脉僵硬度在1年时持续升高,瓣膜类型对结果有轻微影响。尽管生活质量有所改善,但这些发现仍然一致。

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