Bernal J M, Fernández-Vals M, Rabasa J M, Gutiérrez-García F, Morales C, Revuelta J M
Department of Cardiovascular Surgery, Hospital Universitario Valdecilla, Universidad de Cantabria, Santander, Spain.
J Thorac Cardiovasc Surg. 1998 May;115(5):1130-5. doi: 10.1016/S0022-5223(98)70413-1.
To investigate the long-term performance of aortic valve repair, we analyzed the results obtained in a 22-year period in patients who underwent repair of nonsevere rheumatic aortic valve disease during other valvular procedures.
Fifty-three patients (mean 40 +/- 11.6 years of age) with predominant rheumatic mitral valve disease had concomitant aortic valve disease in association with serious tricuspid valve disease in 25 of them. Preoperatively, aortic valve disease was considered moderate in 47.2% of the patients and mild in 52.8%. All patients underwent reparative techniques of the aortic valve (free edge unrolling, 44; subcommissural annuloplasty, 40; commissurotomy, 36) at the time of mitral or mitrotricuspid valve surgery. The completeness of follow-up during the closing interval was 100%, with a mean follow-up of 18.8 years (range 8 to 22.5 years).
Hospital mortality rate was 7.5%. Of 49 surviving patients, 26 (53.1%) died during late follow-up. The actuarial survival curve including hospital mortality was 35.4% +/- 8.7% at 22 years. For patients who underwent mitral and aortic valve surgery, the actuarial survival curve at 22 years was 32.3% +/- 13%, whereas for patients who had a triple-valve operation the survival was 37.0% +/- 10.1% (p = 0.07). Twenty-five patients underwent an aortic prosthetic valve replacement. Actuarial free from aortic structural deterioration and valve-related complications at 22 years was 25.3% +/- 9.3% and 12.7% +/- 4.8%, respectively.
Long-term functional results of reparative procedures of nonsevere aortic valve disease in patients with predominant rheumatic mitral valve disease have been inadequate at 22 years of follow-up. According to these data, conservative operations for rheumatic aortic valve disease do not seem appropriate.
为研究主动脉瓣修复的长期效果，我们分析了在22年期间对非重度风湿性主动脉瓣疾病患者在进行其他瓣膜手术时进行修复所获得的结果。
53例（平均年龄40±11.6岁）以风湿性二尖瓣疾病为主的患者伴有主动脉瓣疾病，其中25例伴有严重三尖瓣疾病。术前，47.2%的患者主动脉瓣疾病被认为是中度，52.8%为轻度。所有患者在二尖瓣或二尖瓣三尖瓣手术时均接受了主动脉瓣修复技术（游离缘展开，44例；瓣下环成形术，40例；交界切开术，36例）。随访期结束时随访完整性为100%，平均随访18.8年（范围8至22.5年）。
医院死亡率为7.5%。49例存活患者中，26例（53.1%）在随访后期死亡。包括医院死亡率在内的22年精算生存曲线为35.4%±8.7%。对于接受二尖瓣和主动脉瓣手术的患者，22年精算生存曲线为32.3%±13%，而接受三尖瓣手术的患者生存率为37.0%±10.1%（p = 0.07）。25例患者接受了主动脉人工瓣膜置换术。22年时无主动脉结构恶化和瓣膜相关并发症的精算生存率分别为25.3%±9.3%和12.7%±4.8%。
在22年的随访中，以风湿性二尖瓣疾病为主的患者非重度主动脉瓣疾病修复手术的长期功能结果并不理想。根据这些数据，风湿性主动脉瓣疾病的保守手术似乎并不合适。
