Taw R L, Pipkin R, Fortuin N J, Brawley R K
Johns Hopkins Med J. 1976 Sep;139(3):85-91.
Thirty-three patients who had aortic valve replacement (AVR) for isolated aortic stenosis (AS) were retrospectively evaluated to determine the influence of preoperative ventricular function on the results of operation. Patients were arbitrarily divided by ejection fraction (EF) into Group I having EF 0.46 or above and Group II having EF 0.45 or below. Group II had significantly lower mean EF and cardiac index and higher left ventricular end-diastolic volume index and end-diastolic pressure. There were two early and no late deaths in 21 Group I patients. There were no early and five late deaths in 12 Group II patients. All Group I survivors and six of 12 Group II patients were New York Heart Association (NYHA) functional Class I or II at follow-up evaluation. No preoperative hemodynamic index was predictive of which Group II patients would do well. Mortality was substantially higher in patients with severe preoperative disability. Early or late death occurred in five of 12 patients who were NYHA functional Class IV before operation but in only two of 21 patients who were functional Class II or III preoperatively. We conclude that patients with isolated AS and poor left ventricular function have a low hospital mortality but an increased risk of late death or poor functional result following AVR. Excellent functional results can be obtained after AVR in most patients with AS and good left ventricular function and approximately half of the patients with AS and poor left ventricular function.
对33例因单纯主动脉瓣狭窄（AS）而行主动脉瓣置换术（AVR）的患者进行回顾性评估，以确定术前心室功能对手术结果的影响。根据射血分数（EF）将患者任意分为两组：I组EF为0.46或以上，II组EF为0.45或以下。II组的平均EF和心脏指数显著较低，左心室舒张末期容积指数和舒张末期压力较高。21例I组患者中有2例早期死亡，无晚期死亡。12例II组患者无早期死亡，有5例晚期死亡。在随访评估中，所有I组幸存者和12例II组患者中的6例纽约心脏协会（NYHA）心功能分级为I级或II级。没有术前血流动力学指标能够预测哪些II组患者预后良好。术前严重功能障碍的患者死亡率显著更高。术前NYHA心功能IV级的12例患者中有5例发生早期或晚期死亡，而术前心功能II级或III级的21例患者中仅有2例发生。我们得出结论，单纯AS且左心室功能差的患者住院死亡率低，但AVR后晚期死亡风险或功能结果不佳的风险增加。大多数AS且左心室功能良好的患者以及约一半AS且左心室功能差的患者在AVR后可获得良好的功能结果。
