■根据2020年美国心脏病学会/美国心脏协会指南,在严重的主动脉瓣狭窄或反流的情况下,应更换主动脉瓣,独立于左心室功能(即使EF<55%)。然而,在临床实践中,尤其是在非常低的EF范围内,由于担心手术风险,外科医生可以避免外科主动脉瓣置换术(SAVR).这项研究检查了EF≤35%接受SAVR的患者的预后。
■从2004年到2019年,我们机构的一名外科医生对895名患者进行了主动脉瓣狭窄(AS)和/或反流(AR)的SAVR。从这些当中,40例患者(4.47%)的射血分数(EF)为35%或更低,形成学习小组。在40个中的18个中,在术中预防性地放置了主动脉内球囊泵。比较术前和术后超声心动图以确定射血分数的变化。评估中期生存率。
■16位AS患者,20与AR和4的AS和AR的组合。医院生存率为97.5%(1例患者死亡)。随着时间的推移,平均射血分数从最初的26%逐渐提高到中期的46%,平均随访43个月(0.1-140.7)。值得注意的是,研究组与年龄和性别匹配的一般人群的5年生存率相当(p=0.834).观察到LV舒张末期直径和收缩末期直径的下降趋势。前者达到统计学意义(6.0cm至5.3cm;p=0.0046),而后者稍短(4.8厘米至4.1厘米;p=0.056)。使用IABP的患者的EF低于不使用IABP的患者(范围10-35,平均23%vs.15-35%,平均27.6%)。三个亚组的EF在术后显着改善(AS的p<0.001,对于AR,p=0.002,AS和AR的p=0.046)。
■对于EF≤35%的左心室衰竭患者,可以安全地进行手术AVR。随着时间的推移,可以看到射血分数的显著改善。我们认为预防性旁路IABP有一定作用。5年生存率正常化。外科医生应该毫不犹豫地对这些高度危险的患者进行AVR。
UNASSIGNED: According to the 2020 American College of Cardiology/American Heart Association guidelines, the aortic valve should be replaced in the setting of severe aortic stenosis or regurgitation, independent of left ventricular function (even for EF < 55%). However, in clinical practice, especially in a very low EF range, surgeons may avoid surgical aortic valve replacement (SAVR) because of concern over operative risk. This study examines outcomes of patients with EF ≤ 35% undergoing SAVR.
UNASSIGNED: From 2004 to 2019, 895 patients underwent SAVR for aortic stenosis (AS) and/or regurgitation (AR) by a single surgeon at our institution. From among these, 40 patients (4.47%) had an ejection fraction (EF) of 35% or less, forming the study group. Intra-aortic balloon pump was placed intraoperatively prophylactically pre-bypass in 18 out of the 40. Preoperative and post-operative echocardiograms were compared to determine changes in ejection fraction. Mid-term survival was assessed.
UNASSIGNED: 16 patients presented with AS, 20 with AR, and 4 with a combination of AS and AR. Hospital survival was 97.5% (one patient death). The average ejection fraction progressively improved over time from 26% initially to 46% mid-term with mean follow-up of 43 months (0.1-140.7). Remarkably, five-year survival was comparable between the study group and an age- and gender-matched general population (p = 0.834). Downward trends in LV end-diastolic diameter and end-systolic diameter were seen. The former achieved statistical significance (6.0 cm to 5.3 cm; p = 0.0046), while the latter fell slightly short (4.8 cm to 4.1 cm; p = 0.056). Patients in whom an IABP was used had lower EFs than those without IABP (range 10-35, mean 23% vs. 15-35%, mean 27.6%). The EFs of the three subgroups improved significantly postoperatively (p < 0.001 for AS, p = 0.002 for AR, and p = 0.046 for AS and AR).
UNASSIGNED: Surgical AVR can be done safely in patients with a failing LV with EF ≤ 35%. Significant improvements in the ejection fraction are seen over time. We believe there is a role for prophylactic pre-bypass IABP. Five-year survival is normalized. Surgeons should not hesitate to perform AVR in these highly jeopardized patients.