老年主动脉瓣狭窄患者主动脉瓣置换术后升主动脉改变的中远期结果  

Ascending Aorta Changes After Aortic Valve Replacement in Elderly Patients With Aortic Stenosis

作　　者：龚嘉淼 安康 林宏远 唐汉韡 朱坤[1] 侯剑峰[1] GONG Jiamiao;AN Kang;LIN Hongyuan;TANG Hanwei;ZHU Kun;HOU Jianfeng(Adult Cardiac Surgery Center,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing(100037),China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院成人外科中心,北京市100037

出　　处：《中国循环杂志》2022年第11期1123-1129,共7页Chinese Circulation Journal

摘　　要：目的:评估老年主动脉瓣狭窄患者主动脉瓣置换术后升主动脉直径变化情况及升主动脉扩张的危险因素。方法:回顾性收集2016年1月至2016年12月在中国医学科学院阜外医院接受主动脉瓣置换术且不同期处理升主动脉的151例老年(≥65岁)主动脉瓣狭窄患者,其中有≥1年超声心动图随访数据且存活的患者87例,根据术前升主动脉直径将其分为术前升主动脉直径<40 mm组(n=59)和术前升主动脉直径≥40 mm组(n=28)。收集患者围术期及随访数据,分析术后升主动脉直径变化情况及升主动脉扩张的危险因素。结果:平均随访(4.0±1.3)年时,术前升主动脉直径≥40 mm组的升主动脉直径由出院时(38.1±5.0)mm增大至(41.2±4.3)mm,升主动脉直径/体表面积从出院时(23.3±3.9)mm/m^(2)增加至(25.0±3.6)mm/m^(2)(P均<0.01);而术前升主动脉直径<40 mm组的升主动脉直径变化及升主动脉直径/体表面积与出院时的差异均无统计学意义(P均>0.05)。术前升主动脉直径≥40 mm组的升主动脉扩张速率明显高于术前升主动脉直径<40 mm组(0.74 mm/年vs.0.13 mm/年,P=0.025)。线性混合效应模型分析显示,术前升主动脉直径是术后升主动脉扩张速率的危险因素;术前升主动脉直径<40 mm组主动脉瓣置换术后升主动脉扩张速率小于术前升主动脉直径≥40 mm组(P<0.01)。151例患者中,随访期间死亡11例(7.3%),其中心脏相关死亡3例(2例因心力衰竭死亡,1例因心肌梗死死亡),未发生主动脉相关事件,也无患者行主动脉相关的再次手术。结论:老年主动脉瓣狭窄患者的术前升主动脉直径是术后升主动脉扩张速率的重要危险因素。对于术前升主动脉直径≥40 mm的患者,术后需定期随访复查和监测。Objectives: To describe the natural history of the ascending aorta in elderly patients after aortic valve replacement for aortic stenosis and to clarify the risk factors associated with the progression of the ascending aorta.Methods: This retrospective analysis enrolled a total of 151 elderly patients(≥ 65 years old) who had undergone aortic valve replacement for severe aortic stenosis in Fuwai Hospital from January 2016 to December 2016, including 87 survived patients with more than 1 year echocardiographic follow-up data. The patients were categorized into two groups based on the diameter of the ascending aorta before aortic valve replacement, as determined by echocardiography and computed tomography: Group A(n=28) with ascending aortic diameters ≥40 mm, and Group B(n=59) with ascending aortic diameters <40 mm. The perioperative and follow-up data were collected, and a linear mixed-effect model was used to analyze and compare the enlargement rates of the ascending aorta after aortic valve replacement.Results: The mean follow-up period was(4.0±1.3) years. The baseline diameter of the ascending aorta was(38.1±5.0)mm in Group A and the value of the ascending aorta diameter/body surface area was(23.3±3.9) mm/m^(2), which increased to(41.2±4.3) mm and(25.0±3.6) mm/m^(2) respectively during the follow-up period(both P<0.01). However, these values did not change in group B(both P>0.05). The enlargement rate of the ascending aorta after aortic valve replacement was significantly greater in group A than in group B(0.74 mm/year vs. 0.13 mm/year, P=0.025). Linear mixed model analysis revealed that the baseline ascending aortic diameter was the only significant risk factor for the postoperative dilation rate of ascending aorta.The dilation rate of ascending aorta after aortic valve replacement in Group B was lower than that in Group A(P<0.01). 11patients(7.3%) died during follow-up, including 3 cardiac deaths(2 died of heart failure and 1 died of myocardial infarction).There was no aortic event and reoperation in

关 键 词：老年人 主动脉瓣狭窄 主动脉瓣置换术 升主动脉直径 

分 类 号：R54[医药卫生—心血管疾病]