不同术式治疗主动脉瓣下狭窄的中远期疗效

Mid-and long-term results of different techniques for subaortic stenosis

目的评估不同术式治疗主动脉瓣下狭窄的中远期疗效。方法回顾性分析2008年1月—2018年1月在阜外医院行手术治疗的75例主动脉瓣下狭窄患者的临床资料,其中男48例、女27例,年龄72(48,132)个月,体重(21.35±15.82)kg。术前合并主动脉瓣反流40例。首次手术38例(50.7%),二次手术37例(49.0%)。根据手术方式将75例患者分为A组(单纯隔膜切除患者40例)和B组(隔膜与肌肉切除术或改良Konno术患者35例)。结果全组院内死亡2例,死亡率2.67%。远期B组死亡1例。全组患者术前左室流出道压差(69.96±42.02)mm Hg,术后左室流出道压差(7.44±12.45)mm Hg。全组患者中位随访时间为51(12,120)个月。A组与B组随访时左室流出道压差差异无统计学意义[(8.83±14.52)mm Hg vs.(5.86±9.53)mm Hg,P=0.294]。术后再干预患者A组4例,B组2例,两组远期免再干预率差异无统计学意义(P=0.480)。结论针对左室流出道不同的病变程度,本中心的治疗策略合适,并取得了较好的中期结果。单纯隔膜切除术与扩大左室流出道切除术后再次手术率虽然差异无统计学意义,但需延长随访时间以进一步证实不同术式的远期效果。

Objective To evaluate the mid-and long-term outcomes of different surgical techniques for subaortic stenosis.Methods The clinical data of 75 patients with subaortic stenosis who underwent surgery in our hospital from January 2008 to January 2018 were retrospectively analyzed,including 48 males and 27 females,with a median age of 72(48,132)months and mean weight of 21.35±15.82 kg.There were 40(53.3%)patients combined with aortic regurgitation;38(50.7%)patients were the first time and 37 patients were the second time to receive the operation.According to the surgical techniques,75 patients were divided into two groups:a group A(40 patients with simple subaortic membrane resection)and a group B(35 patients with subaortic membrane and muscle resection or modified Konno procedure).Results Two(2.67%)patients died in hospital.There was one late death in the group B.The average preoperative and postoperative pressure gradient of all patients was 69.96±42.02 mm Hg and 7.44±12.45 mm Hg,respectively.All patients were followed up for 51(12,120)months.Pressure gradient at follow-up in the group A and the group B was 8.83±14.52 mm Hg and 5.86±9.53 mm Hg,respectively with no statistical difference(P=0.294).Four patients in the group A and 2 patients in the group B needed reintervention.However,there was no statistical difference in the long-term reintervention rate between the two groups(P=0.480).Conclusion For the different degree of lesions in the left ventricular outflow tract,our management strategy is feasible.Although there is no statistical difference between two the groups in the long-term reintervention rate after simple valvular membrane resection,prolonged follow-up is necessary to examine the long-term outcomes of different surgical techniques.