风湿性二尖瓣合并主动脉瓣病变的外科手术与预后研究  

The research on surgical management and prognosis of aortic valve dysfunction during rheumatic mitral valve surgery

作　　者：刘创 王茂舟 邓秋菊 刘静[1] 姜文剑[1] 张宏家[1] LIU Chuang;WANG Maozhou;DENG Qiuju;LIU Jing;JIANG Wenjian;ZHANG Hongjia(Department of Cardiac Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心脏外科,100029

出　　处：《心肺血管病杂志》2024年第7期736-742,共7页Journal of Cardiovascular and Pulmonary Diseases

基　　金：首都医科大学附属北京安贞医院重大科技创新研发专项(KCZD202203)。

摘　　要：目的:探讨合并轻度及以下或中重度主动脉瓣病变患者的临床情况,研究合并中度主动脉瓣病变患者是否需合并同期手术治疗。方法:本研究为单中心、回顾性队列研究。回顾性收集2016年1月至2022年8月,于首都医科大学附属北京安贞医院接受风湿性二尖瓣手术治疗的844例患者信息,进行为期6年的随访。主要终点事件为随访期间发生中重度主动脉瓣病变。对合并中度主动脉瓣病变患者,通过倾向性评分匹配及逆概率加权调整两组基线资料,使用Cox回归分析计算风险比(HR),使用Logistic回归分析计算比值比(OR)。结果:①共纳入844例风湿性二尖瓣手术患者,合并轻度、中度、重度主动脉瓣病变患者行同期主动脉瓣手术的比例分别为11.0%(38/346)、57.8%(115/199)、94.4%(85/90)。②在风湿性二尖瓣手术合并主动脉瓣中度病变的患者中,经倾向性评分匹配后,手术组随访期间主要终点事件较未手术组少(5.7%vs.23.1%,P=0.023),同期行主动脉瓣手术能够显著降低随访期间中重度主动脉瓣病变率(OR=0.20,95%CI:0.04-0.68,P=0.026),但两组随访期间死亡率及再手术率均差异无统计学意义。在逆概率加权匹配后,仍得到相同的结果。结论:对风湿性二尖瓣疾病合并中度主动脉瓣病变,同期行主动脉瓣外科手术可显著降低随访期间主动脉瓣中重度病变发生率,但对患者死亡及再手术无明显影响。Objective:To describe the clinical situation of patients with aortic valve disease during rheumatic mitral valve disease,and to study whether patients with moderate aortic valve disease need concurrent surgical treatment.Methods:This study was a single center,retrospective cohort study.We retrospectively enrolled patients who underwent rheumatic mitral valve surgery at Beijing Anzhen Hospital from January 2016 to August 2022,and a 6-year follow-up was conducted.The main endpoint event was the occurrence of moderate to severe aortic valve disease during follow-up.For patients with moderate aortic valve disease,propensity score matching and inverse probability treatment weighting were used to adjust the baseline data of two groups.Cox regression analysis was used to calculate the hazard ratio(HR),and logistic regression analysis was used to calculate the odds ratio(OR).Results:A total of 844 patients with rheumatic mitral valve surgery were included.The proportion of patients with mild,moderate,and severe aortic valve disease who underwent aortic valve surgery was 11.0%(38/346),57.8%(115/199),and 94.4%(85/90),respectively.In patients with moderate aortic valve disease during rheumatic mitral valve surgery,after propensity score matching,the surgical group had a lower risk of primary endpoint events during follow-up compared to the non-surgical group(5.7%vs.23.1%,P=0.023).Concomitant aortic valve surgery significantly reduced the rate of moderate to severe aortic valve disease during follow-up(OR=0.20,95%CI:0.04-0.68,P=0.026),but there was no significant difference in mortality rate and reoperation rate between the two groups.After inverse probability treatment weighting,the same result was similar.Conclusions:For patients with moderate aortic valve disease during rheumatic mitral valve disease,concomitant aortic valve surgery can significantly reduce the incidence of moderate to severe aortic valve disease during follow-up,without significant impact on mortality and reoperation.

关 键 词：风湿性心脏病 二尖瓣病变 主动脉瓣病变 主动脉瓣成形术 主动脉瓣置换术 

分 类 号：R54[医药卫生—心血管疾病]