老年性主动脉瓣退行性变的外科疗效分析

CLINICAL EVALUATION OF SURGICAL MANAGEMENT FOR AORTIC VALVE DEGENERATION IN THE ELDERLY

目的评价老年性主动脉瓣退行性变的外科治疗效果.方法回顾分析1994年至2004年间手术治疗老年主动脉瓣退行性变64例患者的临床资料,男性43例,女性21例,年龄65～81岁.主动脉瓣跨瓣平均压差24～72mmHg,其中37例合并有主动脉瓣关闭不全.心功能Ⅱ级19例、Ⅲ级37例、Ⅳ级8例.10例合并有冠心病.手术在全麻中度低温体外循环下进行,切除主动脉瓣,置换生物瓣29例,机械瓣35例.同期进行的手术包括:冠状动脉旁路(CABG)9例,CABG+升主动脉人工血管置换术1例,房间隔缺损修补2例,二尖瓣成形2例,主动脉窦瘤修补1例.结果术后早期死亡率7.8%(5/64).手术主要并发症包括:应用永久心脏起搏器3例,一过性肾功能不全3例(其中2例行短期透析治疗).平均ICU停留时间1～8日.9例患者使用主动脉内反搏球囊(IABP).远期死亡4例,其中1例死亡原因为脑出血,3例为肿瘤.出院时心功能Ⅰ级27例、Ⅱ级31例、Ⅲ级1例,较术前明显改善.结论手术是治疗老年性主动脉瓣退行性变安全有效的方法.

Objectives To investigate the clinical outcome of surgical management for aortic degeneration in the elderly. Methods Sixty four patients ( 43 male and 21 female ) older than 65 years with aortic valve degeneration underwent aortic valve replacement (AVR) between 1994 and 2004. Mean age was 72.5±3.2 years, transvalvular mean pressure gradient was 24~72 mmHg. Aortic regurgitation was detected in 37 patients. The majority were in NYHA class III and IV. Bioprothesis and mechanical prostheses were implanted respectively in 29 and 35 patients. Concomitant CABG was performed in 9 patients, CABG plus ascending aorta replacement in 1 patient, ASD closure in 2 patients, mitral valvuloplasty in 2 patients, and repair of the sinus of Valsalva in 1 patients. Results Early mortality (< 30 days) was 7.8% (5/64). IABP assistance was needed in 9 patients. Major complications were complete atrioventricular block and permanent pacemaker implantation in 3 patients, transient renal impairment in 3 patients. On the day of discharge 27 patients were in NYHA class I, 31 in class II and 1 in class III. There were 4 late death, 1 from cerebral bleeding and 3 from malignancy. Conclusions When applied in appropriately selected candidates, AVR even with concomitant CABG can be performed with acceptable mortality in the elderly with aortic stenosis.