主动脉瓣狭窄伴低射血分数值患者行外科瓣膜置换术的疗效评价

Clinical evaluation of aortic valve replacement in patients with aortic stenosis and decreased left ventricular ejection fraction

目的通过回顾性分析主动脉瓣狭窄(AS)合并左室射血分数(LVEF)减低患者的临床资料评价行外科主动脉瓣置换(SAVR)术后的临床疗效。方法回顾性分析武汉亚洲心脏病医院2020年8月至2022年6月中-重度AS(瓣口面积<1.5 cm2)、LVEF减低(<50%)并行SAVR的患者共44例,其中男性39例,女性5例,年龄41~74(59.30±8.65)岁,伴或不伴主动脉瓣关闭不全,除外二尖瓣重度狭窄或关闭不全。收集患者基线资料、既往病史、术前及术后超声心动图结果、手术相关数据等指标。出院前复查超声心动图,并于术后6个月、1年随访观察。结果围术期1例患者因重度肺部感染、多器官功能衰竭,家属要求放弃治疗,主动出院,余43例患者均手术成功。与术前相比,出院前主动脉瓣跨瓣流速(AV)及主动脉瓣跨瓣压差(AMG)均有显著下降(均P<0.05),左心房内径、左心室舒张末期直径也明显减小(均P<0.05);LVEF于术后6个月、1年明显改善,由术前(40.23±4.96)%显著提高至(52.65±2.92)%(P<0.05)。AV和AMG在术后1周与随访期间相比较无明显变化(P>0.05)。1例患者在随访过程中因感染性心内膜炎入院治疗,治愈出院;1例患者随访期间主动脉瓣人工瓣膜狭窄,未出现明显临床症状,体力劳动未受明显限制,定期随访观察未行手术治疗。结论AS合并LVEF降低的患者行SAVR是安全、有效的,术后AV、AMG、左室内径及LVEF均有明显改善,此类患者均应积极采取外科手术方式干预治疗。

Objective To evaluate the clinical efficacy and prognosis of aortic valve replacement in patients with aortic stenosis and decreased left ventricular ejection fraction through retrospectively analyses.Methods A retrospective analysis of the clinical data of 44 patients undergoing surgical aortic valve replacement with aortic stenosis(AS)(valve area<1.5 cm2)and decreased left ventricular ejection fraction(LVEF<50%)from August 2020 to June 2022 in Asia Heart Hospital was conducted,including 39 males and 5 females,aged from 41 to 74 years(mean 59.30±8.65 years),with or without aortic regurgitation,except for moderate to severe mitral stenosis or regurgitation.The baseline data,past medical history,preoperative and postoperative cardiac ultrasound results as well as the procedure-related data were collected.All patients was assessed by echocardiography before AVR and before discharge,as well as 6 months,and 1 year after AVR.Results One patient was asked to be discharged from hospital by his family because for severe pulmonary infection and multiple organs dysfunction syndrome after operation.The other 43 patients were followed up for 1 year after operation.Compared with pre-operation,the aortic valve transvalvular flow velocity and aortic valve mean transvalvular pressure gradient had both decreased significantly as early as before discharge post operation(all P<0.05),the diameter of left atrium and the left ventricular end-diastolic diameter were significantly decreased as well(all P<0.05),and the left ventricular ejection fraction remained improved up to 6 months and 1 year post operation,increasing significantly from(40.23±4.96)%to(52.6±2.92)%(P<0.05).AV and AMG were significantly decreased before discharge after operation,but had no significant change in the follow-up period(P>0.05).During the follow up period,one patient was admitted to the hospital for endocarditis and was cured and discharged.One patient had aortic valve stenosis during the follow-up period without obvious clinical symptoms and physical labor was not obviously restricted,performing regular follow-up observation.Conclusion Surgical aortic valve replacement is an effective and safe treatment for patients with aortic stenosis with decreased left ventricular ejection fraction,the transaortic gradient,aortic valve transvalvular flow velocity,left ventricular end-diastolic diameter and left ventricular ejection fraction were significantly improved after operation,therefore,this kind of patients should take active surgical treatment.