高龄钙化性主动脉瓣重度狭窄患者的临床研究

Clinical Research of Severe Aortic Valve Stenosis in Older Patients

目的评价高龄钙化性主动脉瓣重度狭窄患者临床特点,对比不同治疗方案的预后。方法连续回顾收集我院住院诊断重度主动脉瓣狭窄高龄患者226例,分为药物组、PBAV、TAVR和SAVR,随访观察全因死亡终点。结果患者平均年龄78.9±3.1岁,四组死亡率为46.6%、44.4%、7.2%、6.5%。TAVR、SAVR较药物组死亡率减低(p<0.0001)。多因素回归分析显示,糖尿病(OR=0.65,95%CI:1.056-3.471)、EF(OR=-0.036,95%CI:0.945-0.984)、合并二/三尖瓣病(OR=0.742,95%CI:1.104-3.991)是1年全因死亡独立危险因素。结论糖尿病、EF、合并二/三尖瓣病是高龄重度主动脉瓣狭窄1年全因死亡独立危险因素,换瓣手术较药物治疗明显改善预后。

Objective To analyze the risk factors of older patients with calcific severe aortic valve stenosis. We sought to analyze mortality and to compare the security of different treatment. Methods We retrospectively enrolled 226 consecutive patients older than 75 years who were diagnosed aortic severe stenosis between January 2008 and January 2015 in our institution. All patients were followed at 1 year. Compare the differences in mortality among groups of drug treatment, PBAV, TAVR and SAVR. Results The mortality of drug group, PBAV, TAVR, SAVR were 46.1%, 44.4%, 7.2%, 6.5%. The mortality was significantly difference between drug and TAVR/SAVR（p〈0.0001）. Three variables including diabetes mellitus（OR=0.65, 95% CI： 1.056-3.471）, EF（OR=-0.036, 95% CI：0.945-0.984）, Concomitant mitral/tricuspid valve disease（OR=0.742, 95% CI：1.104-3.991）were independently correlated with patient all cause mortality of one year. Conclusion The mortality of drug treatment was higher compared with TAVR and SAVR. Diabetes mellitus, EF, Concomitant mitral/tricuspid valve disease were independently risk factors of 1-year all cause mortality.