二叶式与三叶式主动脉瓣狭窄患者的临床对照研究

A clinical comparative study of patients with bicuspid and tricuspid aortic valve stenosis

目的 通过对二叶式与三叶式主动脉瓣狭窄患者进行临床特征及围术期指标的回顾性对比分析,以期指导二叶式主动脉瓣狭窄患者的术前管理、手术方案制定及术后治疗.方法 选取我院心外科自2011年1月至2017年12月期间收治的所有因主动脉瓣狭窄而单纯行主动脉瓣置换术的患者90例(术中处理主动脉、马方综合征、主动脉夹层及临床资料不全者未纳入本研究),根据瓣叶特点分为二叶式主动脉瓣组(BAV组45例)和三叶式主动脉瓣组(TAV组45例).分别收集两组患者围术期临床资料,从术前、术中、术后三个方面对比两组差异,所有资料均应用SPSS 20.0进行相关统计分析.结果 BAV组患者中男性29例、女性16例,约2∶1.在术前指标对比方面,相比较TAV组,BAV组发病年龄明显较小[(47.76±10.80)岁比(54.58±9.29)岁,P=0.002],合并升主动脉扩张的比例高(66.7%比37.8%,P=0.006),且升主动脉直径更大[(39.55±6.77)mm比(35.55±4.78)mm,P=0.002];BAV组合并三尖瓣反流的比例明显高于TAV组(62.2%比40.0%,P=0.035);对比两组左心室内径、主动脉瓣口流速及跨瓣压差,未见统计学差异(P>0.05).在术中指标对比方面,BAV组主动脉阻断时间明显长于TAV组[(72.07±22.05)min比(55.80±16.77)min,P=0.000].在术后指标对比方面,两组患者在ICU时间、ICU呼吸机时间、住院时间及复查超声上未见统计学差异(P>0.05).结论 二叶式主动瓣狭窄患者容易较早发病,并且具有男性优势,所以应提高心脏疾病筛查能力,以便于早诊断、早治疗.同时,二叶式主动脉瓣狭窄患者易合并升主动脉扩张和三尖瓣反流,且升主动脉直径和主动脉阻断时间明显大于三叶式主动脉瓣狭窄患者,因此依据指南并结合手术经验术中积极处理扩张主动脉、修复三尖瓣是非常必要的,此外还应加强围手术期心肌保护、缩短阻断时间来减少术中损害.

Objective To analyze retrospectively the clinical features and perioperative indexes in patients with bisuspid and tricuspid aortic valve stenosis in order to guide the preoperative treatment of patients with bicuspid aortic valve stenosis.Methods A total of 90 patients(The patients with surgical management of aortic,Marfan's syndrome,aortic dissection and incomplete clinical data were not included in this study)who underwent aortic valve replacement for aortic stenosis from January 2011 to December 2017 in our hospital were selected.According to the characteristics of the valve,they were divided into bicuspid aortic valve group(BAV group.n=45)and tricuspid aortic valve group(TAV group,n=45).The clinical data of the two groups during perioperative period were collected and compared with each other in three stage:preoperative,intraoperative and postoperative.All the data were analyzed by SPSS 20.0.Results In BAV group.there were 29 males and 16 females,about 2:1.Compared with TAV group,the age of onset in BAV group was significantly younger [(47.76±10.80)years old vs.(54.58 ±9.29)years old,P=0.002] and the proportion of ascending aortic dilatation was higher(66.7% vs.37.8%,P=0.006).The diameter of ascending aorta in BAV group was larger than TAV group[(39.55±6.77)mm vs.(35.55 ±4.78)mm,P=0.002].The proportion of BAV combination with tricuspid regurgitation was significantly higher than TAV group(62.2% vs.40.0%.P=0.035).There was no significant diflerence in left ventricular diameter,aortic valve velocity and transvalvular pressure between the two groups(P>0.05).Aortic occlusion time in BAV group was significantly longer than that in TAV group [(72.07±22.05)min vs.(55.80±16.77)min,P=0.000].There was no significant difference in ICU time.ICU ventilator time,hospitalization time and reexamination ultrasound between the two groups(P>0.05).Conclusion The patients with bicuspid aortic valve stenosis are prone to early onset and more male.Therefore.the screening of heart disease should be improved so as to facilitate diagnosis and treatment early.Moreover,patients with bicuspid aortic valve stenosis were more likely to be associated with ascending aortic dilatation and tricuspid regurgitation and the bigger diameter of ascending aorta and the duration of aortic occlusion were significantly longer than patients with tricuspid aortic valve stenosis.Therefore,it is necessary to actively deal with dilated aorta and repair tricuspid valve according to the guidelines and operative experience.In addition,myocardial protection during perioperative period should be strengthen and the duration of occlusion should be shorten to reduce intraoperative damage.