主动脉瓣修复术治疗风湿性主动脉瓣病变的术后中期疗效评估  

Mid-term clinical outcome analysis of aortic valve repair for rheumatic aortic valve disease

作　　者：李岩[1] 付金涛 焦玉清[1] 贾一新[1] 许春雷[1] 陈宏[1] 胡秋明[1] 陈宗浩 韩薇[1] 孟旭[1] Li Yan;Fu Jintao;Jiao Yuqing;Jia Yixin;Xu Chunlei;Chen Hong;Hu Qiuming;Chen Zonghao;Han Wei;Meng Xu(Department of Cardiac Surgery Center,Beijing Anzhen Hospital Affiliated with Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心脏外科中心,100029

出　　处：《中华胸心血管外科杂志》2021年第8期467-471,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的评估风湿性心脏病患者主动脉瓣修复手术后近中期疗效。方法2016年1月至2020年12月,共54例风湿性心脏病患者在北京安贞医院接受主动脉瓣修复手术。男25例,女29例,年龄(50.61±13.29)岁。单纯主动脉瓣关闭不全31例(57.4%),单纯主动脉瓣狭窄2例(3.7%),复合病变21例(38.9%);同期合并二尖瓣手术43例(80.0%),三尖瓣手术36例(66.7%),房颤射频消融术20例(37.0%)。随访1~61个月(中位随访时间25个月),利用配对秩和检验比较非独立研究对象连续性变量差异,Kaplan-Meier方法分析患者随访期间的临床结局。结果术前主动脉瓣中重度反流比例高于出院时,主动脉瓣口最大流速、左心室舒张期末内径显著低于出院指标(P值均<0.05)。全因死亡2例,术后5年生存率(96.1±2.7)%;主动脉瓣再次手术5例,术后5年主动脉瓣免于再次手术率(89.5±4.5)%;瓣膜相关并发症3例,术后5年免于瓣膜相关并发症率(91.3±4.2)%。结论主动脉瓣修复手术治疗风湿性主动脉瓣病变具备可行性且近中期效果良好,可成为一种潜在的可靠治疗选择。Objective To evaluate the mid-term outcomes of patients with rheumatic heart disease who underwent aortic valve repair surgery in a prospective cohort.Methods From January 2016 to December 2020,a total of 54 patients with rheumatic heart disease underwent aortic valve repair surgery in Beijing Anzhen Hospital,with an average age of(50.61±13.29)years,including 29 females(53.7%).There were 31 patients(57.4%)had pure aortic insufficiency,2 patients(3.7%)had pure aortic stenosis and 21 patients(38.9%)had mixed lesion.During the same period,43 patients(80.0%)underwent mitral valve surgery,36 patients(66.7%)underwent tricuspid valve surgery,and 20 patients(37.0%)underwent atrial fibrillation radiofrequency ablation.The follow-up period was from 1 month to 61 months(median follow-up was 25 months).Paired rank-sum test was used to compare the differences in continuous variables among subjects,and Kaplan-Meier method was used to analyze the clinical outcomes during the follow-up period.Results Proportion of moderate and severe aortic regurgitation Preoperatively was higher than that of discharge data,aortic valve orifice maximum velocity and left ventricular end-diastolic diameter were significantly lower than discharge data(all P<0.05).The 5-year survival rate was(96.1±2.7)%(2 patients died).The 5-year freedom from reoperation after aortic valve repair was(89.5±4.5)%(5 patients underwent redo surgery).The 5-year freedom from valvular-related complications was(91.3±4.2)%(3 patients suffered from complications).Conclusion Aortic valve repair surgery for rheumatic aortic valve disease is feasible and has excellent early and mid-term results,it can be a reliable treatment option.

关 键 词：风湿性心脏病 主动脉瓣修复术 疗效分析 

分 类 号：R654.2[医药卫生—外科学]