主动脉瓣置换术治疗严重主动脉瓣反流合并严重左心室功能不全远期疗效分析

Long-term outcomes of Aortic Valve Replacement for Patients with Severe Aortic Regurgitation and Severe Left Ventricular Dysfunction

目的分析严重主动脉瓣关闭不全合并左心功能衰竭的患者行主动脉瓣置换术的远期疗效。方法回顾性分析2002年1月至2012年12月鼓楼医院44例严重主动脉瓣反流及左心功能衰竭患者的临床资料。全组均患有严重左心功能不全、左心室射血分数（LVEF）≤35%,其中男29例、女15例,年龄23~78（44±6）岁;LVEF为22%~34%（29%±3%）。全组均行主动脉瓣置换术。结果围术期死亡2例,死亡原因为心力衰竭。术中体外循环时间57~92（73±8）min,主动脉阻断时间33~61（48±6）min。术后住ICU时间2~15（8±3）d。全组随访1~11（4.3±2.9）年。随访期间死亡2例,其中1例死于心功能障碍,另1例死于脑卒中。术后1年生存率为93%,术后5年生存率为91%。结论主动脉瓣置换术能够明显延长严重主动脉瓣反流合并左心功能衰竭患者的生存时间。

Objective To analyze long-term outcomes of aortic valve replacement（AVR） for patients with severe aortic regurgitation（AR） and left ventricular dysfunction（LVD）. Methods We retrospectively analyzed clinical data of 44 patients with severe AR and LVD who received AVR in Drum Tower Hospital from January 2002 to December 2012. Left ventricular ejection fraction（LVEF） of all the patients was lower than 35%. There were 29 male and 15 female patients with their age of 23-78（44±6） years and LVEF of 22%-34%（29%±3%）. Results Two patients died because of heart failure postoperatively. Cardiopulmonary bypass time was 57-92（73±8） minutes,aortic cross-clamping time was 33-61（48±6）minutes, and length of ICU stay was 2-15（8±3） days. All the patients were followed up for 1-11（4.3±2.9） years. Two patients died during follow-up because of heart failure and stroke respectively. One-year survival rate was 93% and five-year survival rate was 91%. Conclusion AVR can significantly increase long-time survival of patients with severe AR and LVD.