心室功能对主动脉瓣关闭不全外科治疗效果的影响

Influence of ventricular function on surgical treatment of patients with severe aortic regurgitation

目的分析主动脉瓣关闭不全合并不同程度左心室功能障碍患者的临床资料,探讨左心室功能对此类患者外科手术风险及早期疗效的影响。方法回顾性分析2001年1月至2008年12月144例主动脉瓣关闭不全患者的临床资料,按左心室射血分数(LVEF)将其分为3组(LVEF<35%组,LVEF35%～45%组和LVEF45%～55%组),采用SPSS统计软件分析患者手术并发症、死亡率及术后早期左心室重构、收缩功能变化等情况。结果主动脉瓣关闭不全合并不同程度左心室功能障碍患者在性别、年龄及术前心功能状况等方面差异无统计学意义,术后低心排综合征、肾功能不全、恶性心律失常的发生率差异亦无统计学意义;但LVEF<35%组的术后死亡率明显高于其他两组(18.5%比9.1%、2.7%,P<0.05);各组术后早期左心室舒张末直径及左心室LVEF均较术前有明显改善[左心室舒张末直径:LVEF<35%组:(61.4±16.2)mm比(78.2±14.9)mm,LVEF35%～45%组:(62.2±10.8)mm比(64.4±13.1)mm,LVEF45%～55%组:(54.6±12.1)mm比(60.4±12.3)mm;LVEF:LVEF<35%组:36.4%±9.2%比27.3%±4.4%,LVEF35%～45%组:44.6%±13.3%比40.2%±2.7%,LVEF45%～55%组:52.3%±10.4%比50.5%±3.0%,均为P<0.05]。结论对于左心室功能严重减退(LVEF<35%)的主动脉瓣关闭不全患者外科治疗风险较大,围术期死亡率较高,但采取合适的外科治疗方案,仍能取得较好的治疗效果。

Objective To analyze clinical data of aortic valve replacement （AVR） for patients with severe aortic regurgitation and markedly reduced left ventricular function and to explore the potential factors. Methods The study group consisted of 144 patients who underwent AVR for isolated severe aortic regurgitation with reduced left ventricular function. Clinical data of the patients were retrospectively collected and compared among patients with markedly reduced left ventricular ejection fraction （LVEF） （ 〈35% ）, among moderately reduced LVEF （35% to 45% ） and with mildly reduced LVEF （45% to 55% ）. Results Baseline data and early postoperative complication rate were similar among 3 groups. Mortality rate was significantly higher in LVEF 〈 35% group than in other two groups （ P 〈 0. 05 ）. The severity of left ventricular remodeling and LVEF were improved significantly in early postoperative period but no difference among the 3 groups. Conclusions Patients with severe aortic regurgitation and markedly reduced LVEF are deemed to be at greater risk for surgical treatments, and with high mortality during the perioperative period, but appropriate surgical therapy may be effective.