The aortic stenosis complex: aortic valve, atherosclerosis, aortopathy
The aortic stenosis complex: aortic valve, atherosclerosis, aortopathy
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DOI：
10.1016/j.jjcc.2014.12.021
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发表时间：
2015-05-01
影响因子：
2.5
通讯作者：
Sai-Sudhakar, Chittoor B.
中科院分区：
文献类型：
--
作者：
Boudoulas, Konstantinos Dean;Wolfe, Brian;Sai-Sudhakar, Chittoor B.
背景资料：三叶式主动脉瓣患者的主动脉瓣狭窄可能与冠状动脉粥样硬化有关，而二叶式主动脉瓣患者常存在主动脉扩张。我们试图确定在一个大型转诊医疗中心接受主动脉瓣狭窄手术的三叶或二叶主动脉瓣患者的主动脉瓣狭窄、冠状动脉粥样硬化和胸主动脉瘤之间的关系。结果：1999年1月至1999年12月间，共行主动脉瓣置换术（AVR）的175例（三尖瓣175例，二尖瓣95例）。三尖瓣与二叶主动脉瓣相比，更常需要冠状动脉旁路移植术（CABG）+AVR [62.2% vs 26.3%; p <0.0001;比值比4.5，置信区间（CI）2.5 - 8.3]。二叶式主动脉瓣冠状动脉粥样硬化需要CABG的发生率（26.3%）高于相似年龄的一般人群的预期发生率。与三尖瓣主动脉瓣相比，二尖瓣主动脉瘤加AVR导致的胸主动脉手术更常见（27.3% vs 3.4%; p <0.0001;比值比7.7，CI 3.0 - 22.1）。升主动脉瘤的发病率需要手术，但是，并不常见于三尖瓣主动脉瓣（3.4%），在一般人群中预期的相似again.Conclusion：冠状动脉粥样硬化的发病率高，主动脉瓣狭窄的患者，无论是在三尖瓣和二尖瓣主动脉瓣。升主动脉瘤的发生率在二叶型主动脉瓣患者中较高，而在三叶型主动脉瓣患者中不高。这些发现应考虑到在评估和管理的患者与主动脉瓣狭窄复杂。(C)2015年日本心脏病学院。由爱思唯尔有限公司出版。保留所有权利。
Background: Aortic stenosis may be related to coronary atherosclerosis in patients with tricuspid aortic valve, while aortic dilatation often is present in patients with bicuspid aortic valve. We sought to define associations among aortic stenosis, coronary atherosclerosis, and thoracic aortic aneurysm in patients with tricuspid or bicuspid aortic valve undergoing surgery for aortic stenosis in a large referral medical center.Methods: Two hundred seventy patients with severe aortic stenosis (tricuspid 175, bicuspid 95) undergoing surgical aortic valve replacement (AVR) were studied.Results: Coronary artery bypass grafting (CABG) surgery plus AVR was required more often in tricuspid compared to bicuspid aortic valve [62.2% versus 26.3%; p < 0.0001; odds ratio 4.5, confidence interval (CI) 2.5-8.3]. The incidence of coronary atherosclerosis requiring CABG in bicuspid aortic valve (26.3%) was greater than that expected in the general population for similar age. Thoracic aorta surgery due to aortic aneurysm plus AVR was performed more often in bicuspid compared to tricuspid aortic valve (27.3% versus 3.4%; p < 0.0001; odds ratio 7.7, CI 3.0-22.1). The incidence of ascending aorta aneurysm requiring surgery, however, was not more common in tricuspid aortic valve (3.4%) to that expected in the general population for similar age.Conclusion: Incidence of coronary atherosclerosis is high in patients with aortic stenosis, both in those with tricuspid and bicuspid aortic valve. Incidence of ascending aortic aneurysm is high in patients with bicuspid, but not those with tricuspid aortic valve. These findings should be taken into consideration in the evaluation and management of patients with the aortic stenosis complex. (C) 2015 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.