Zhu Ching-Yan, Zhang Jing-Nan, Tse Yi-Kei, Ren Qing-Wen, Huang Jia-Yi, Yu Si-Yeung, Guo Ran, Gu Wen-Li, Chan Daniel Tai-Leung, Lip Gregory Y H, Yiu Kai-Hang
Division of Cardiology, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shen Zhen, China.
Division of Cardiology, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China.
Glob Heart. 2025 Aug 28;20(1):71. doi: 10.5334/gh.1462. eCollection 2025.
The clinical significance of atherosclerotic disease in more than one vascular bed, that is, polyvascular disease, in valvular heart surgery remains poorly understood. This study aims to establish the prevalence and prognostic value of polyvascular disease for long-term outcomes after valvular heart surgery.
Patients receiving valvular heart surgery at two tertiary centres from January 1, 2010 to December 31, 2021 were identified. We examined the effect of atherosclerotic disease in three major vascular beds, including coronary artery disease (CAD), ischaemic cerebrovascular accidents (CVA) and peripheral vascular disease (PVD), on postoperative major adverse cardiac events (MACE) and all-cause mortality. Polyvascular disease was defined as atherosclerotic disease in ≥2 vascular beds.
Of 3843 patients (mean age 58 ± 13 years; 52% male), 1266 (33%) had atherosclerotic disease in ≥1 vascular beds, including 207 (5.4%) with polyvascular disease. Patients with vascular disease were older with more comorbidities, higher surgical risk and more aortic stenosis. Over a median follow-up of 6.37 years (IQR: 3.40-9.54), patients with polyvascular disease had the greatest long-term MACE risk [HR: 1.68 (1.35-2.10)], followed by those with monovascular disease [HR: 1.43 (1.24-1.65)]. Both monovascular and polyvascular disease independently predicted mortality and MACE. Patients with extracardiac vascular disease had independently greater long-term MACE risk than CAD [HR: 1.56 (1.27-1.92)].
Patients undergoing valvular heart surgery exhibit a high prevalence of vascular disease. The risk of adverse outcomes rises with both the presence and extent of vascular disease, and extracardiac vascular disease confers greater risk of MACE than CAD.
在心脏瓣膜手术中，多血管床的动脉粥样硬化疾病（即多血管疾病）的临床意义仍未得到充分了解。本研究旨在确定多血管疾病在心脏瓣膜手术后长期预后中的患病率及预后价值。
确定2010年1月1日至2021年12月31日在两个三级中心接受心脏瓣膜手术的患者。我们研究了三个主要血管床的动脉粥样硬化疾病，包括冠状动脉疾病（CAD）、缺血性脑血管意外（CVA）和外周血管疾病（PVD），对术后主要不良心脏事件（MACE）和全因死亡率的影响。多血管疾病定义为≥2个血管床存在动脉粥样硬化疾病。
在3843例患者（平均年龄58±13岁；52%为男性）中，1266例（33%）在≥1个血管床存在动脉粥样硬化疾病，其中207例（5.4%）患有多血管疾病。患有血管疾病的患者年龄更大，合并症更多，手术风险更高，主动脉狭窄更多。在中位随访6.37年（IQR：3.40 - 9.54）期间，患有多血管疾病的患者长期发生MACE的风险最高[HR：1.68（1.35 - 2.10）]，其次是患有单血管疾病的患者[HR：1.43（1.24 - 1.65）]。单血管和多血管疾病均独立预测死亡率和MACE。患有心脏外血管疾病的患者长期发生MACE的风险独立高于CAD[HR：1.56（1.27 - 1.92）]。
接受心脏瓣膜手术的患者血管疾病患病率较高。不良结局的风险随着血管疾病的存在和程度而增加，且心脏外血管疾病导致MACE的风险高于CAD。
