Impact of residual regurgitation after aortic valve replacement
Impact of residual regurgitation after aortic valve replacement
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DOI：
10.1093/ejcts/ezs083
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发表时间：
2012-09-01
影响因子：
3.4
通讯作者：
Voisine, Pierre
中科院分区：
文献类型：
--
作者：
Sponga, Sandro;Perron, Jean;Voisine, Pierre
标准主动脉瓣置换术后，轻至中度主动脉瓣反流 (AR) 并不罕见，据报道，经导管主动脉瓣植入后更常见。患者通常通过观察性随访进行管理，但残留 AR 的临床意义和自然史尚不清楚。本研究的目的是确定其对这些患者预后的影响。1992 年至 2011 年间，我们机构连续 3201 名患者接受了隔离标准主动脉瓣置换术。其中，135 名患者 (4.2%) 发现瓣周漏 > 1/4。研究了临床、术中以及术后早期和晚期结果变量。通过多变量分析评估与残余 AR 相关的因素及其对生存的影响。平均随访时间为 4.5 +/- 3.4 年。生物假体的使用、较长的体外循环持续时间和术前心房颤动与出现残余 AR 的较高风险相关。常见的合并症（糖尿病、中风、肺部疾病、肾功能衰竭、周围血管疾病）以及 > 1/4 残留 AR 的存在也会对生存产生负面影响。后一组患者在所有时间点的生存率均低于 AR < 1/4 的患者：1 年、5 年和 10 年分别为 91.4 vs 96.7%、77.5 vs 82.4% 和 44.1 vs 54.5% (P < 0.01)。术后残余 AR > 1/4 是术后死亡率的独立预测因子，在为患者选择手术方法和管理策略时应予以考虑需要标准 和经导管主动脉瓣置换术。
Mild-to-moderate aortic regurgitation (AR) is not infrequently encountered after standard aortic valve replacement, and reportedly more often following transcatheter aortic valve implantation. Patients are usually managed by observational follow-up, but the clinical significance and natural history of residual AR are unknown. The goal of this study was to determine its impact on the outcome of these patients.Between 1992 and 2011, 3201 consecutive patients underwent isolated standard aortic valve replacement in our institution. Of these, 135 patients (4.2%) were found to have paravalvular leak > 1/4. Clinical, intraoperative as well as early and late postoperative outcome variables were studied. Factors associated with residual AR and their impact on survival were assessed by multivariate analysis.Mean follow-up was 4.5 +/- 3.4 years. The use of a bioprosthesis, longer cardiopulmonary bypass duration and preoperative atrial fibrillation were associated with a higher risk of presenting residual AR. Survival was negatively affected by commonly identified comorbidities (diabetes, stroke, pulmonary disease, renal failure, peripheral vascular disease) but also by the presence of > 1/4 residual AR. Survival in the latter group was lower than for patients with < 1/4 AR at all time points: 91.4 vs 96.7%, 77.5 vs 82.4% and 44.1 vs 54.5% at 1, 5 and 10 years, respectively (P < 0.01).Postoperative residual AR > 1/4 is an independent predictor of postoperative mortality and should be considered in the selection of surgical approach and management strategy for patients in need of standard and transcatheter aortic valve replacement.