Different Clinical Outcome of Paravalvular Leakage After Aortic or Mitral Valve Replacement
Different Clinical Outcome of Paravalvular Leakage After Aortic or Mitral Valve Replacement
复制标题
DOI：
10.1016/j.amjcard.2010.09.014
复制
发表时间：
2011-01-15
影响因子：
2.8
通讯作者：
Ha, Jong-Won
中科院分区：
文献类型：
--
作者：
Cho, In Jeong;Moon, Jeonggeun;Ha, Jong-Won
尽管主动脉瓣置换术 (AVR) 和二尖瓣置换术 (MVR) 是最常进行的人工瓣膜置换手术，但尚不清楚 MVR 或 AVR 后瓣周漏 (PVL) 的临床结果是否不同。据推测，AVR 后 PVL 的临床结果将比 MVR 后更有利，因为发生在收缩期的二尖瓣位置的 PVL 的压力梯度比主动脉瓣处的压力梯度大得多。在 12 年的时间里，共鉴定出 82 名 PVL 患者。排除因严重症状需要立即手术修复的患者、Behget 病或感染性心内膜炎患者以及累及双瓣膜的 PVL 患者后，剩下 54 名轻度至中度渗漏的患者（21 名女性，平均年龄 56 +/- 14 岁，23 个 AVR）构成研究人群。终点包括心源性死亡、全因死亡率、重复手术和因心力衰竭紧急入院。中位随访时间为 35 个月，共发生 27 起事件，其中 23 起重复手术、2 起心源性死亡、1 起非心源性死亡和 1 起因心力衰竭入院。 Cox 回归分析显示，PVL 的瓣膜位置是无事件生存的唯一独立临床预测因子。 AVR 后 PVL 患者的估计 8 年无事件生存率显着高于 MVR 后患者（70 +/- 12% vs 16 +/- 8%，p
Although aortic valve replacement (AVR) and mitral valve replacement (MVR) are the most commonly performed prosthetic valve replacement operations, it is unclear whether clinical outcomes of paravalvular leakage (PVL) after MVR or AVR are different. It was hypothesized that clinical outcomes of PVL after AVR would be more favorable than after MVR because the pressure gradient is much larger in PVL occurring at the mitral position, which happens at the systolic phase, than at the aortic valve. Over a 12-year period, 82 patients with PVL were identified. After excluding patients who required immediate surgical repair for severe symptoms, patients with Behget disease or infective endocarditis, and those with PVL involving both valves, 54 remaining patients (21 women, mean age 56 +/- 14 years, 23 AVRs) with mild to moderate leakage constituted the study population. The end points were cardiac death, all-cause mortality, repeat surgery, and urgent admission for heart failure. During a median follow-up period of 35 months, there were 27 events, including 23 repeated surgeries, 2 cardiac deaths, 1 noncardiac death, and 1 admission for heart failure. Cox regression analysis revealed that the valve location of PVL was the only independent clinical predictor of event-free survival. The estimated 8-year event-free survival rate was significantly higher in patients with PVL after AVR than those after MVR (70 +/- 12% vs 16 +/- 8%, p