2018 年第 6 期 第 13 卷

主动脉瓣重度狭窄合并左心室功能重度减低患者的手术疗效分析

Curative effect of surgical treatment on severe aortic valve stenosis complicated with severe left ventricular dysfunction

作者：郑居兵董然刘韬帅赵洋李扬张魁伯平谢进生

英文作者：

单位：100029首都医科大学附属北京安贞医院心脏外科

英文单位：

关键词：主动脉瓣狭窄；左心室功能减低

英文关键词：

• 摘要：

• 【摘要】目的    分析主动脉瓣重度狭窄合并左心室功能严重减低患者的手术疗效。方法    选取2010年 1月至2017年8月在首都医科大学附属北京安贞医院心脏外科接受主动脉瓣置换术的主动脉瓣重度狭窄合并左心室功能重度减低（左心室射血分数≤35%）的患者39例。分析术后早期结果和随访结果。结果    手术体外循环时间（84±44）min，主动脉阻断时间（68±30）min。人工瓣膜机械瓣32例，生物瓣7例。瓣膜大小：19号瓣5例，21号瓣18例，23号瓣9例。围术期死亡4例，死亡原因为低心排血量综合征（2例）、血行感染（2例）；术后左心室射血分数明显高于术前［（38±6）%比（30±7）%］，差异有统计学意义（P<0.05）。随访2～92月，中位时间49个月。第1、3、5年存活率分别为87.2%（34/39）、79.5%（31/39）、66.7%（26/39）。结论    主动脉瓣重度狭窄合并左心室功能严重减低这类病例，手术仍能获得较满意的疗效，术后左心室功能也能得到一定的改善。

• 【Abstract】Objective    To analyze the surgical outcomes of patients with severe aortic valve stenosis complicated with severe left ventricular dysfunction. Methods    Thirty-nine patients with severe aortic valve stenosis complicated with severe left ventricular dysfunction（left ventricular ejection fraction≤35%） undergoing aortic valve replacement from January 2010 to August 2017 in Beijing Anzhen Hospital, Capital Medical University were enrolled. Surgical records, postoperative and follow-up data were analyzed. Results    Mean cardiopulmonary bypass time was (84±44)min; mean aortic clamp time was (68±30)min. Thirty-two mechanical prosthetic valve and 7 biological valve were implanted; the valve type included size 19(5 cases), size 21(18 cases) and size 23(9 cases). Two patients died of low cardiac output syndrome and 2 patients died of hematogenous infection during perioperative period. Left ventricular ejection fraction after operation was significantly higher than that before operation［（38±6）% vs （30±7）%］(P<0.05). The median follow-up time was 49 months（2-92 months）. The 1-, 3-, 5-year survival rate were 87.2%（34/39）, 79.5%（31/39） and 66.7%（26/39）, respectively. Conclusions    urgical operation shows a satisfactory curative effect on severe aortic valve stenosis complicated with severe left ventricular dysfunction.