巨大左心室主动脉瓣置换术的远期疗效——125例随访报告

Long-term results of aortic valve replacement for aortic valve disease with large left ventricle in 125 patients

目的 随访巨大左心室单纯主动脉瓣置换术治疗的远期疗效 ,并分析其影响因素。方法 对 12 5例左心室舒张末径 (LVDD)大于 70mm行主动脉瓣置换手术的病人采用信访、电话随访和门诊复查相结合的方法进行长期随访。终止日期为 1998年 12月 ,随访时间为 1～ 14年 ,平均 (6 6± 3 4 )年。随访到 12 3例 ,完整随访率为 98 4 %。结果 远期死亡 15例 ,5年生存率为 90 1% ,10年生存率为81 2 %。瓣周漏 5例 ,生物瓣坏损再次置换 5例。 3年及 5年免除心脏事件发生率为 87 3%和 79 4 %。随访结果与术前及术后早期结果进行统计学处理 ,LVDD、左室射血分数 (LVEF)及心功能等指标均显著改善 (P <0 0 5 )。死亡组术前的LVDD和LVEF与生存组对比差异存在显著性。多因素相关分析显示 ,LVEF小于 0 4 0、LVDD大于 85mm为独立相关危险因素 (P <0 0 5 )。结论 巨大左心室单纯主动脉瓣病变行主动脉瓣置换手术 ,远期疗效良好。左心室扩大的可复性 ,应从术前LVEF、LVDD、病变性质、年龄等因素综合考虑。

Objective: This clinical study was designed to evaluate the long term results in patients after aortic valve replacement for aortic valve disease with large left ventricle. Methods: Between 1980 and 1996, 133 patients with left ventricular end diastolic diameter larger than 70 mm underwent aortic valve replacement. Among the 125 survivals, 123 patients (98.4%) were followed up for and average time of 6 6 years (with 14 years maximum). Results: There was no hospital death. 15 patients died during the follow up period. The survival rates at 5 and 10 years were 90.1% and 81 2%, respectively. Functional status improved significantly, especially in left ventricular end diastolic diameter and left ventricular ejection fraction. There was significant improvement in mean NYHA from class 2 9±0 3 to 1 5±0 7. By multivariate analysis, left ventricular end diastolic diameter larger than 85 mm and left ventricular ejection fraction lower than 40% are independent risk factors. Conclusion: Aortic valve replacement is a reliable therapeutic intervention for patients with large left ventricle, and it can be performed with good results. Patients who benefit most from the operation were those with a normal postoperative contraction pattern.