Impact of preoperative left ventricular ejection fraction on long-term survival after aortic valve replacement for aortic stenosis.
Impact of preoperative left ventricular ejection fraction on long-term survival after aortic valve replacement for aortic stenosis.
复制标题
术前左心室射血分数对主动脉瓣狭窄主动脉瓣置换术后长期生存的影响。
DOI：
10.1161/circoutcomes.112.965772
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发表时间：
2013
期刊：
影响因子：
--
通讯作者：
Ross,Cathy
中科院分区：
文献类型：
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作者：
Goldberg,JoshuaB;DeSimone,JosephP;Kramer,RobertS;Discipio,AnthonyW;Russo,Louis;Dacey,LawrenceJ;Leavitt,BruceJ;Helm,RobertE;Baribeau,YvonR;Sardella,Gerald;Clough,RobertA;Surgenor,StephenD;Sorensen,MeredithJ;Ross,Cathy
BackgroundThe生存的患者接受主动脉瓣置换术（AVR）的严重主动脉瓣狭窄减少术前射血分数（EF）是没有很好地描述在literature.Methods和ResultsPatients接受AVR的严重主动脉瓣狭窄进行了分析，使用北方新英格兰心血管疾病研究组手术注册。患者按术前EF（≥ 50%、40%-49%和<40%）和合并冠状动脉旁路移植术分层。估计患者在首次入院后8年内的EF分层的粗生存率和校正生存率。1992年至2008年期间，共有5277例患者因重度主动脉瓣狭窄接受了AVR。有727例（14%）患者术前EF <40%。术前EF对术后发病率的影响极小。在孤立性AVR队列中，各EF分层的30天死亡率无差异。在AVR+冠状动脉旁路移植术人群中，保留EF可带来30天生存获益（EF≥ 50%，96%; EF<40%，91%;P=0.003）。保留EF的患者有显着改善6个月和8年的生存率相比，他们减少EF countermeasurement.ConclusionsSurvival AVR或AVR+冠状动脉旁路移植术后是最有利的术前保留EF的患者。然而，与接受药物治疗的患者的自然病史相比，轻度至中度EF降低的患者经历了实质性的生存获益。此外，EF的轻微降低与功能受损更严重的患者风险增加相同，表明即使在心肌功能轻微降低之前进行AVR，患者也能得到最好的服务。
BackgroundThe survival of patients who undergo aortic valve replacement (AVR) for severe aortic stenosis with reduced preoperative ejection fractions (EFs) is not well described in the literature.Methods and ResultsPatients undergoing AVR for severe aortic stenosis were analyzed using the Northern New England Cardiovascular Disease Study Group surgical registry. Patients were stratified by preoperative EF (≥50%, 40%–49%, and <40%) and concomitant coronary artery bypass grafting. Crude and adjusted survival across strata of EF was estimated for patients up to 8 years beyond their index admission. A total of 5277 patients underwent AVR for severe aortic stenosis between 1992 and 2008. There were 727 (14%) patients with preoperative EF <40%. Preoperative EF had minimal effect on postoperative morbidity. There was no difference in 30-day mortality across EF strata among the isolated AVR cohort. Preserved EF conferred 30-day survival benefit among the AVR+coronary artery bypass grafting population (EF≥50%, 96%; EF<40%, 91%;P=0.003). Patients with preserved EF had significantly improved 6-month and 8-year survival compared with their reduced EF counterparts.ConclusionsSurvival after AVR or AVR+coronary artery bypass grafting was most favorable among patients with preoperative preserved EF. However, patients with mild to moderately depressed EF experienced a substantial survival benefit compared with the natural history of medically treated patients. Furthermore, minor reductions of EF carried equivalent increased risk to those with more compromised function suggesting patients are best served when an AVR is performed before even minor reductions in myocardial function.