Lieberman E B, Wilson J S, Harrison J K, Pieper K S, Kisslo K B, Lowe J, Douglas J, Van Trigt P, Glower D D, Davidson C J
Division of Cardiology, Duke University Medical Center, Durham, NC.
Circulation. 1994 Nov;90(5 Pt 2):II205-8.
Percutaneous balloon aortic valvuloplasty is limited by a high risk of procedural morbidity, transient clinical benefit, and a high restenosis rate. The management of patients with symptomatic aortic valve restenosis after percutaneous balloon aortic valvuloplasty is unclear. We hypothesized that aortic valve replacement would produce superior midterm survival compared with repeat balloon aortic valvuloplasty or medication alone in patients with symptomatic aortic valve restenosis after prior balloon aortic valvuloplasty.
Baseline clinical, echocardiographic, and hemodynamic data were collected on 165 patients who underwent percutaneous balloon aortic valvuloplasty as treatment for symptomatic degenerative calcific aortic stenosis. In 144 of these patients (87%), aortic valve replacement was originally considered to carry excessive risk. The survival of three subgroups was calculated during a median follow-up period of 3.9 years (range, 1 to 6 years). Ninety-four patients (57%) had no further mechanical intervention (subgroup 1-BAV), 31 patients (19%) developed symptomatic aortic valve restenosis and underwent a repeat balloon aortic valvuloplasty (subgroup 2-BAV), and 40 patients (24%) subsequently underwent aortic valve replacement (subgroup BAV+AVR). Follow-up was 99% complete. Patients in subgroup BAV+AVR tended to be younger and have a lower prevalence of coronary artery disease or mitral regurgitation. Only 1 patient (2.5%) suffered a perioperative death during aortic valve replacement. The probability of survival 3 years from the date of the last mechanical intervention was 13% for subgroup 1-BAV, 20% for subgroup 2-BAV, and 75% for subgroup BAV+AVR. At the conclusion of follow-up, only 2 patients had symptoms of congestive heart failure or angina after aortic valve replacement.
Aortic valve replacement may be performed with a low mortality rate, excellent palliation of symptoms, and prolongation of survival in selected high-risk patients with a history of previous balloon aortic valvuloplasty.
经皮球囊主动脉瓣成形术受到手术并发症高风险、短暂临床获益及高再狭窄率的限制。对于经皮球囊主动脉瓣成形术后出现症状性主动脉瓣再狭窄患者的管理尚不清楚。我们假设，对于既往接受过球囊主动脉瓣成形术后出现症状性主动脉瓣再狭窄的患者，与再次球囊主动脉瓣成形术或单纯药物治疗相比，主动脉瓣置换术可产生更好的中期生存率。
收集了165例接受经皮球囊主动脉瓣成形术治疗症状性退行性钙化性主动脉瓣狭窄患者的基线临床、超声心动图和血流动力学数据。在这些患者中，144例（87%）最初认为主动脉瓣置换术风险过高。在中位随访期3.9年（范围1至6年）内计算了三个亚组的生存率。94例患者（57%）未进行进一步的机械干预（亚组1 - BAV），31例患者（19%）出现症状性主动脉瓣再狭窄并接受了再次球囊主动脉瓣成形术（亚组2 - BAV），40例患者（24%）随后接受了主动脉瓣置换术（亚组BAV + AVR）。随访完成率为99%。亚组BAV + AVR中的患者往往更年轻，冠状动脉疾病或二尖瓣反流的患病率更低。主动脉瓣置换术中仅1例患者（2.5%）发生围手术期死亡。自最后一次机械干预之日起3年的生存率，亚组1 - BAV为13%，亚组2 - BAV为20%，亚组BAV + AVR为75%。随访结束时，主动脉瓣置换术后仅2例患者出现充血性心力衰竭或心绞痛症状。
对于有既往球囊主动脉瓣成形术病史的特定高危患者，主动脉瓣置换术可在低死亡率、良好症状缓解及延长生存期的情况下进行。
