主动脉瓣替换术后近期及晚期左心室功能随访

The Regression of Left Ventricular Dimension and Late Outcome after Aortic Valve Replacement

目的：评价主动脉瓣替换（ＡＶＲ）术后左心功能的近期及其远期效果。方法：对１９７８年１２月至１９９６年１２月期间连续１２９例单纯行ＡＶＲ的病人进行分析。结果：术前Ｂ超示左心室舒张末期内径（ＬＶＥＤＤ）、收缩末期内径（ＬＶＥＳＤ）分别为（６４．５±９．３）ｍｍ、（４４．７±９．９）ｍｍ，术后１４天至３个月分别为（５１．９±７．２）ｍｍ、（３１．５±４．５）ｍｍ（Ｐ＜０．０１）；术后１～２年分别为（４７．６±６．１）ｍｍ、（２９．５±５．４）ｍｍ（Ｐ＜０．０１）。手术死亡率３．９％。术后随访６个月至１６年，平均４．４年，累计随访５０１病人·年。晚期死亡６例（１．２％病人·年），５年及１０年生存率分别为８９．３％、７７．３％。血栓栓塞及与抗凝有关的出血率分别为０．８％病人·年、１．０％病人·年。结论：ＡＶＲ术后９５％病人的心功能恢复至Ｉ或Ｉ级，长期效果满意。故主动脉瓣病变、ＬＶＥＤＤ扩大并出现症状的病人，应行主动脉瓣替换术。

Aim:To identify the determinants of postoperative regression of left ventricular dimension and late outcome after aortic valve replacement(AVR).Clincal material and method:129 consecutive patients undergoing isolated AVR between December 1978 and December 1996 were studied.The mean postoperative follow up interval was 4.4 years,with a total follow up of 501 patient·years.Results:Early mortality rate was 3.9%.Before AVR,left ventricular end diastolic dimension(LVEED)and left ventricular end systolic dimension(LVESD)were(64.5±9.3)mm and(44.7±9.9)mm.Within first three months after AVR,LVEDD and LVESD were significantly decreased to(51.9±7.2)mm and(36.4±8.5)mm,respectively(P<0.01).One year after AVR,further improvement of LVEED and LVESD had been documented[(47.6±6.1)mm and(29.5±5.4)mm,respectively)].The fraction shortening showed further increase in postoperative 1 to 2 years.X ray showed a decrease in the cardiothoracic ratio from 0.62±0.06 to 0.55±0.06 at 14th day to 3 months postoperatively(P<0.01),but no significant change at the latest follow up study.There are 6 late deaths with a late mortality rate of 1.2%.Actuarial survival at 5 and 10 years was 89.3% and 77.3%,respectively.The thromboembolism and anticoagulant related hemorrhage occurred at linerarized rates of 0.8% patient·year and 1% patient·year respectively.74% of the patients discontinued anticoagulation after 2 years postoperatively.The rates of thromboembolic events and anticoagulant related hemorrhage were of no significant difference in patients with or without anticoagulant agents after 2 years.Conclusion:AVR resulted in excellent symptomatic improvement and hemodynamic performance.Our experience indicates that anticoagulant therapy may be discontinued after 2 years postoperatively,but further long term follow up is necessary to confirm it.