Soyer R, Bouchart F, Bessou J P, Redonnet M, Mouton-Schleifer D, Derumeaux G, Arrignon J, Letac B
Department of Thoracic and Cardiovascular Surgery, Charles Nicolle Hospital, Rouen, France.
Eur J Cardiothorac Surg. 1996;10(11):977-82. doi: 10.1016/s1010-7940(96)80400-3.
This study concerns patients who underwent one or several aortic balloon valvuloplasties at our institution and subsequently required cardiac surgery, either on an emergency basis after aortic valvuloplasty or due to the development of aortic stenosis.
Between February 1987 and December 1993, 137 patients (73 male, 64 female, mean age 72 +/- 9 years) underwent aortic valve replacement for calcified aortic stenosis after several percutaneous balloon aortic valvuloplasties. Thirty-one patients were in NYHA stage II, 70 in stage III and 36 in stage IV. Seventy patients had angina (23 stage I or II, 47 stage III or IV) and 24 patients presented syncope or lipothymia. Twenty-three percent had at least two of these three symptoms. The indications for balloon dilatation were non-definitive surgical contraindication or high surgical risk (73), personal choice (49), refusal of surgery (9) and emergency (5:2 massive aortic regurgitation, 1 left ventricle perforation, 1 cardiogenic shock, 1 endocarditis in cardiogenic shock). Seven patients received preoperative aortic valvuloplasty due to a very high operative risk. The average time between dilatation and surgery was 472 days and there was clinical improvement for an average period of 261 days. The aortic valve replacements consisted of 58 mechanical prostheses and 79 xenografts with 22 concomitant procedures.
Operative mortality was eight patients (5.8%). During the follow-up (17.4 +/- 9.2 months), four patients died (3.6%), 91.2% of the patients were in class I and II and 95% were without angina. The actuarial survival rate was 90.5 +/- 6.6% including hospital mortality.
Both our experience and the literature show that balloon aortic valvuloplasty is followed by an immediate improvement in hemodynamic status with a decrease in valve gradient and an increase in valve area. However, the hemodynamic benefit is typically short-lived with a very high restenosis rate. Balloon aortic valvuloplasty is not an alternative to aortic valve replacement, which remains the best treatment for calcified aortic stenosis; the benefits and long-term results of aortic valve replacement are well established, even in the elderly.
本研究关注在我院接受过一次或多次主动脉球囊瓣膜成形术，随后因主动脉瓣膜成形术后紧急情况或主动脉瓣狭窄进展而需要心脏手术的患者。
1987年2月至1993年12月期间，137例患者（男73例，女64例，平均年龄72±9岁）在多次经皮主动脉球囊瓣膜成形术后因钙化性主动脉瓣狭窄接受主动脉瓣置换术。31例患者为纽约心脏协会（NYHA）心功能II级，70例为III级，36例为IV级。70例患者有胸痛（23例为I或II级，47例为III或IV级），24例患者出现晕厥或眩晕。23%的患者至少有这三种症状中的两种。球囊扩张的适应证为非明确的手术禁忌证或手术风险高（73例）、个人选择（49例）、拒绝手术（9例）和紧急情况（5例：2例严重主动脉瓣反流、1例左心室穿孔、1例心源性休克、1例心源性休克合并心内膜炎）。7例患者因手术风险极高而接受术前主动脉球囊瓣膜成形术。扩张与手术之间的平均时间为472天，临床改善平均持续261天。主动脉瓣置换包括58个机械瓣膜和79个异种生物瓣膜，同时进行了22项其他手术。
手术死亡8例（5.8%）。在随访期间（17.4±9.2个月），4例患者死亡（3.6%），91.2%的患者为I级和II级，95%的患者无胸痛。包括住院死亡率在内的精算生存率为90.5±6.6%。
我们的经验和文献均表明，主动脉球囊瓣膜成形术后血流动力学状态立即改善，瓣膜压差降低，瓣口面积增加。然而，血流动力学益处通常是短暂的，再狭窄率非常高。主动脉球囊瓣膜成形术并非主动脉瓣置换术的替代方法，主动脉瓣置换术仍是钙化性主动脉瓣狭窄的最佳治疗方法；即使在老年人中，主动脉瓣置换术的益处和长期效果也已得到充分证实。
