摘要
目的:总结主动脉瓣环扩大联合环上型生物瓣膜替换策略,治疗老年小瓣环主动脉瓣狭窄的近中期结果,探讨老年小瓣环主动脉瓣狭窄的治疗策略。方法:2010年1月至2017年1月,28例老年小瓣环主动脉瓣狭窄患者应用主动脉瓣环扩大联合环上型生物瓣替换策略进行治疗,主动脉瓣关闭不全或多个瓣膜病变等排除在本研究之外。男性8例,女性20例,年龄65~77岁,平均(70. 5±3. 48)岁,体表面积1.55~1. 72m^2,平均(1.63±0. 05) m^2。按病因分类,退行性主动脉瓣狭窄17例,先天性二叶畸形6例,风湿性改变4例,其他病变1例。患者术前心功能分级(NYHA分级):II级6例,EI级20 例,IV级2例。同时合并疾病包括冠心病5例,2型糖尿病8例,高血压病7例,慢性肾功能不全5例,慢性阻塞性肺疾病3例,心房颤动7例,既往卒中史6例。手术前超声心动图测主动脉瓣环径(17. 5±1.02) mm,平均跨瓣压差(59. 8± 10.2) mmHg (1 mmHg = 0.133 kPa)。结果:体外循环时间(105. 0±18. 8)min,心肌血运阻断时间(71. 0±17.1)min。实测主动脉瓣环径(18. 1±0. 87)mm,应用Nick法扩环 25例,Nufiez法3例,扩环后主动脉瓣环径(22. 2±0. 93)mm,平均增加(4. 13±0. 78)mm,平均替换瓣膜尺寸(21.8±0.99)mm,预期有效瓣口面积指数(1. 10±0.07)cm^2/m^2。同期行冠状动脉旁路移植术5例,心房颤动射频消融术7例,左心耳切除术7例。围手术期死亡1例(3. 6%),死因为低心排血量综合征。开胸止血术1例,急性肾衰竭1例,肺部感染2例,切口并发症1例,临时起搏治疗6例。出院时平均跨瓣压差(13. 14±2. 14)mmHg,超声实测有效瓣口面积指数(I. 12±0.07)cm^2/m^2,仅1例发生轻度患者-人造瓣膜不匹配。手术后2年,常规超声心动图检查及临床评估。24例患者心功能I级,3例II级。患者平均跨瓣压差及左心室质量指数较术前明显改善[(59. 8± 10. 18)VS.(13. 8± 1.93) mmHg,P<0. 01;(151. 3±9. 95)vs.(110. 6±6. 95)g/m^2,P<0. 01 ]。5例患者主动脉�
Objective : To summarize the short and mid-term outcomes of aortic root enlargement with supraannular bioprostheses replacement to treat aged patients ( Age ≥ 65 year) with aortic stenosis and small aortic root and evaluate the optimal strategy to deal with this challenger. Methods: From January 2010 to Janu-ary 2017, 28 aged patients( Age ≥ 65 year) with aortic stenosis and small aortic root who underwent aortic valve replacement (AVR) and aortic root enlargement were included in the cohort. Patients with aortic insufficiency who underwent AVR or those who underwent combined valve replacement/repair were excluded from this study cohort. Mean age was (70. 5±3. 48) years (ranging:65-77 years) and 20 patients (71. 4%) were female. The body surface area was ( 1. 63±0. 05) m^2(ranging 1. 55-1. 72 m^2).The pathology included degenerative AS ( 17 patients),bicuspid aortic valve ( 6 patients ),rheumatism ( 4 patients ) and others ( 1 patients ). Preoperatively, 6 patients were in New York Heart Association functional class Ⅱ, 20 patients in class Ⅲ and 2 patients in class Ⅳ. The comorbidities included coronary artery disease ( 5 patients), diabetes mellitus ( 8 patients), hypertension (7 patients), chronic kidney disease (5 patients), chronic obstructive pulmonary dis-ease (3 patients), atrial fibrillation ( 7 patients) and history of stroke ( 6 patients ). Preoperative aortic annular diameter measured by echocardiography was (17.5±1. 02) mm and mean transvalvular pressure gradients was (59. 8±10. 2) mmHg (1 mmHg = 0. 133 kPa). Results: Cardiopulmonary bypass time was (105±18. 8) min and aortic cross-clamping time was (71±17. 1) min. The aortic annular diameter measured in operation was (18. 1 ±0. 87) mm. The aortic root was enlarged by Nick4 s technique in 25 patients and by Nunez's technique in 3 patients. The mean aortic annular diameter after root enlargement was (22. 2±0. 93) mm and the augment of aortic annular diameter was (4. 13±0. 78) mm. The mean prosthesis size implanted was ( 21. 8±0. 99)
作者
张富恩
李继勇
伯平
张健群
曹向戎
李温斌
陈宝田
ZHANG Fuen;LI Jiyong;BO Ping;ZHANG Jianqun;CAO Xiangrong;LI Wenbin;CHEN Baotian(Department of Cardiac Surgery , Beijing Anzhen Hospi-tal, Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029, China)
出处
《心肺血管病杂志》
2019年第4期382-386,390,共6页
Journal of Cardiovascular and Pulmonary Diseases
