主动脉瓣机械瓣置换术后远期升主动脉内径变化随访研究

Long-term Follow-up Study of Ascending Aortic Diameter Changes in Patients After Mechanical Aortic Valve Replacement

目的：本研究回顾性分析主动脉瓣机械瓣置换术后升主动脉内径的变化。方法：检索2000-01至2001-12年阜外医院行主动脉瓣置换术（AVR）或主动脉瓣联合二尖瓣置换术（BVR）病历及与其匹配的超声心动图报告,检索条件是主动脉瓣结构为机械瓣且随访超声心动图资料累计在9年及以上,采集患者临床资料和术前、术后随访经胸常规二维超声心动图报告。超声随访时长分为≤3年、3年〈~≤6年、6年〈~≤9年、〉9年,统计分析各随访时间段患者升主动脉内径的变化。以基线升主动脉内径分为〈35 mm患者和≥35 mm患者来观察升主动脉事件发生率。结果：141例患者入选[男75例,平均年龄（45.5±11.2）岁],共检索595份超声报告,平均超声随访年数（7.59±3.38）年。各随访时间段的升主动脉内径随访值与基线值比较,≤3年和3年〈~≤6年时间段的差异无统计学意义（P〉0.05）,6年〈~≤9年,〉9年差异有统计学意义（P〈0.05）。基线升主动脉内径≥35 mm患者行二次手术的比例为24.0%,高于基线升主动脉内径〈35 mm患者的12.9%。5例升主动脉事件均发生在基线升主动脉内径≥35 mm患者中,发生率达20.0%。结论：主动脉瓣机械瓣置换术后升主动脉内径呈渐进性增宽,增宽者的所占比亦增大,基线升主动脉内径≥35 mm患者行再次手术和发生升主动脉事件的风险较高。临床上需慎重考虑合并升主动脉扩张的主动脉瓣瓣膜疾患的手术处理方法。

Objective： To retrospectively analyze the ascending aortic diameter（AAD） changes in patients after mechanical aortic valve replacement（AVR）.Methods： The medical records and echocardiography reports in patients who received AVR or bivalve valve replacement（BVR） in our hospital from 2000-01 to 2001-12 were retrieved, the retrieval conditions were as aortic valve structure must be mechanical and the follow-up echocardiography examination should be more than 9 years. The clinical information, pre- and post-operative 2-dimentional transthoracic echocardiography reports were collected, the follow-up echocardiography periods were ≤3-year, 3-year-≤6-year, 6-year-≤9-year and 9-year. AAD changes at different periods were compared. According to baseline AAD, the patients were divided into AAD35 mm group and AAD≥35 mm group in order to observe the ascending aortic events. Results： A total of 141 patients were enrolled form 595 echocardiography reports which included 75 male, the patients were at the mean age of（45.5 ± 11.2） years with mean follow-up time of（7.59 ± 3.38） years. Compared with baseline level, the follow-up AAD was similar between ≤3-year and 3-year-≤6-year patients, P〈0.05; while the follow-up AAD was different between 6-year-≤9-year and 9-year patients, P〈0.05. The patients with second operation in AAD≥35 mm group were much higher than those in AAD35 mm group（24.0% vs 12.9%）. There were 5（20%） patients suffered from ascending aortic eventsin AAD≥35 mm group.Conclusion： AAD dilatation were gradually occurring after mechanical AVR, the patients with AAD≥35 mm had the higher risk for ascending aortic events, therefore special attention should be taken in patients with aortic valve disease combining AAD dilatation during surgical treatment.