Ali Montasir H, Mushtaq Amir, Bakhsh Abdul R A, Salem Ahmed, Abdulwahid Kawan, Ionescu Adrian
Specialist Registrar in Cardiology.
Internal Medicine Trainee Glangwili General Hospital, Hywel Dda University Health Board, Dolgwili Road, Carmarthen, SA31 2AF.
Br J Cardiol. 2023 Sep 5;30(3):26. doi: 10.5837/bjc.2023.026. eCollection 2023.
Surgical aortic valve replacement (SAVR) prolongs life and improves its quality in patients with severe aortic stenosis (AS). Unplanned SAVR is a failure of AS screening and follow-up programmes. We identified all elective, first, isolated SAVRs performed between 1 January and 31 December 2019 in a Welsh tertiary cardiac centre, and documented the clinical and echocardiographic variables, and reasons for unplanned SAVR. Of 140 isolated SAVR, 37 (26%) were unplanned (16 female, mean age 72.3 ± 8.4 years). Twenty had been on the SAVR waiting list and had expedited operations because of concerns about the severity of the AS (12 patients), or because of acute (four patients) or chronic (four patients) left ventricular failure (LVF). Of the 17 not on the waiting list, AS was known in seven: three had acute pulmonary oedema while under follow-up with 'moderate AS', one had been referred but developed pulmonary oedema while waiting for a surgical outpatient appointment, one refused SAVR but was subsequently admitted with acute pulmonary oedema and accepted SAVR, one was admitted directly from home because concerns about worsening AS, and one had infective endocarditis with severe aortic regurgitation. Of 10 patients with a new diagnosis of AS, five presented with LVF, four with angina and in three there was a history of syncope (p=0.003 known AS; multiple symptoms). Survival, age, Canadian Cardiovascular Society (CCS) and New York Heart Association (NYHA) class, number of risk factors, peak and mean aortic valve (AV) gradients, AV area, and stroke volume index were not different between patients who had planned versus unplanned SAVR, or with known or new AS. Patients with a new diagnosis of AS had longer pre-operative wait (22.3 ± 9.3 6.0 ± 10.3 days, p<0.001). In conclusion, a quarter of SAVRs are unplanned and half are in patients without a prior diagnosis of AS. Unplanned SAVR is associated with prolonged length of hospital stay and with a history of syncope, but other conventional clinical and echocardiographic parameters do not differ between patients undergoing planned versus unplanned SAVR.
外科主动脉瓣置换术（SAVR）可延长重度主动脉瓣狭窄（AS）患者的寿命并改善其生活质量。非计划性SAVR是AS筛查和随访计划的失败。我们确定了2019年1月1日至12月31日在威尔士一家三级心脏中心进行的所有择期、首次、孤立性SAVR手术，并记录了临床和超声心动图变量以及非计划性SAVR的原因。在140例孤立性SAVR中，37例（26%）为非计划性（16例女性，平均年龄72.3±8.4岁）。20例曾在SAVR等待名单上，因担心AS的严重程度（12例患者）、急性（4例患者）或慢性（4例患者）左心室衰竭（LVF）而加快了手术。在未在等待名单上的17例患者中，7例已知患有AS：3例在“中度AS”随访期间出现急性肺水肿，1例已转诊但在等待外科门诊预约时出现肺水肿，1例拒绝SAVR但随后因急性肺水肿入院并接受了SAVR，1例因担心AS恶化直接从家中入院，1例患有感染性心内膜炎并伴有严重主动脉瓣反流。在10例新诊断为AS的患者中，5例出现LVF，4例出现心绞痛，3例有晕厥史（已知AS患者p=0.003；多种症状）。计划性与非计划性SAVR患者之间，或已知与新诊断为AS的患者之间，生存率、年龄、加拿大心血管学会（CCS）和纽约心脏协会（NYHA）分级、危险因素数量、主动脉瓣（AV）峰值和平均梯度、AV面积及每搏量指数均无差异。新诊断为AS的患者术前等待时间更长（22.3±9.3对6.0±10.3天，p<0.001）。总之，四分之一的SAVR手术是非计划性的，其中一半是既往未诊断为AS的患者。非计划性SAVR与住院时间延长和晕厥史相关，但计划性与非计划性SAVR患者之间的其他传统临床和超声心动图参数并无差异。
