Valvular Replacement for Patients with Aortic Stenosis and Severe Left Ventricular Dysfunction

背景　主動脈瓣狹窄患者併發心臟衰竭後的兩年存活率不及百分之十；此外，進行外科手術的風險也會增加。本研究的目的是要評估主動脈瓣膜置換手術在這樣的病患的風險與效益。方法　從1999年5月至2003年4月，共有連續8名主動脈瓣狹窄併發嚴重左心室功能不良（心臟射出分率小於30%）的患者在台大醫院接受主動脈辦膜置換手術。心肌保護的方式是初始順流灌注，繼之以連續的逆流冷血液或電解質溶液灌注。手術的適應症為嚴重主動脈瓣狹窄，定義是主動脈瓣面積≦1平方公分或是以都卜勒氏超音波量測的最大壓力差≧50 mmHg。平均病患年齡為67±9歲，其中有七位病患有嚴重的運動性呼吸困難(New York Heart Association functional class Ⅲ-Ⅳ)，有五位在手術前已經呼吸衰竭。結果　手術後短期內（30天）的死亡率為0％。在追蹤期間內（平均32±18月）的存活率為75%，所有病患心臟衰竭的症狀都獲得改善。平均心臟射出分率進步26±18單位（p值＝0.005)，左心室收縮和舒張末期直徑分別縮小16±8 （p值＝0.001）和11±8mm （p值＝0.005）結論　主動脈瓣狹窄併發嚴重左心室功能不良患者進行主動脈瓣膜置換手術之風險是可以接受的。本研究大部分的病患獲得了症狀、心臟大小及左心室收縮功能之改善。

關鍵字

主動脈瓣狹窄；瓣膜置換手術；左心室功能不良；左心室改造

並列摘要

Background and Purpose: The 2-year survival of patients with aortic stenosis (AS) and congestive heart failure is less than 10% under medical treatment. On the other hand, the surgical risk of aortic valve replacement (AVR) also increases for patients with AS and severe left ventricular (LV) dysfunction. The aim of this study was to evaluate the risk and benefit of AVR for such patients. Methods: From May 1999 to April 2003, 8 consecutive patients with AS and severe LV dysfunction (ejection fraction [HF]≤30%) underwent aortic valve replacement in National Taiwan University Hospital. The myocardial protection was initially achieved with antegrade perfusion and maintained with continuous retrograde cold blood or crystalloid cardioplegia. The indication for aortic valve replacement was severe AS, which was defined as an aortic valve area of≤1.0 cm^2 or a maximum pressure gradient of≥50 mmHg assessed by Doppler echocardiography. The mean age was 67±9 years; and 7 of 8 patients suffered from severe exertional dyspnea (functional class Ⅲ-Ⅳ of New York Heart Association). Respiratory failure developed in 5 patients prior to surgery. Results: The perioperative (30-day) mortality was 0%. During a mean follow-up period of 32±18 months (range 16-61 months), the survival rate was 75%. The clinical symptoms of heart failure improved at least one functional class in all patients. The mean change of LVEF was an increase of 26±18 EF units (p=0.005), and the mean reductions of LV end-systolic dimension and LV end-diastolic dimension were 16±8 (p=0.001) and 11±8mm (p=0.005), respectively. Conclusions: The surgical risk was acceptable for AVR in patients with AS and severe LV dysfunction. Improvements in symptoms, heart size and LV systolic function were observed in most patients.

並列關鍵字

Aortic stenosis ； Valvular replacement ； Left ventricular dysfunction ； Left ventricular remodeling

國際替代計量

Valvular Replacement for Patients with Aortic Stenosis and Severe Left Ventricular Dysfunction

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