升主动脉成形术治疗主动脉瓣病变合并升主动脉扩张的中期疗效分析
发布时间：2018-10-14 15:40
【摘要】：目的分析升主动脉成形术治疗主动脉瓣病变合并升主动脉扩张的中期临床疗效。方法回顾性地分析2010年1月至2013年12月因主动脉瓣病变合并升主动脉扩张于我院行主动脉瓣置换术合并升主动脉成形术的患者。入组患者102例,所有患者均接受主动脉瓣置换术合并升主动脉成形术,按照术前诊断及术后病理结果将主动脉瓣二瓣化患者(57例)和主动脉瓣非二瓣化患者(45例)分组进行分析。患者平均年龄为52.7±12.9岁,男性患者占71.6%,42.2%术前心功能分级大于2级,术前左心室舒张末径为56.9±9.1mm,射血分数为61.3%±8.9%,术前主动脉窦部内径为35.9±5.3mm,术前升主动脉内径为45.6±4.9mm。结局事件为术后死亡、再次手术、脑卒中、主动脉不良事件(夹层、破裂)。结果对所有入组患者术后随访资料进行分析,平均随访时间为38.8±13.0月。两组患者在年龄上存在统计学差异(二瓣化组49.5±13.5岁vs.非二瓣化组56.8±10.9岁,P=0.004),非二瓣化组较二瓣化组有更多患者合并二尖瓣病变(p0.01)及合并三尖瓣关闭不全(p0.01),术前左心房内径二瓣化组明显小于非二瓣化组(p=0.004),二瓣化组较非二瓣化组有更多患者术前升主动脉内径大于45mm(p=0.004),其余基线资料均具有可比性。术后死亡2例,脑卒中1例,无再次手术及发生主动脉不良事件患者。所有患者术后左心房内径、左室舒张末期内径、主动脉窦部内径、升主动脉内径均较术前明显减小(p0.001)。所有随访升主动脉内径较术后扩张的患者平均主动脉扩张程度为0.39±0.26cm,平均主动脉内径扩张速率为1.3±0.8mm/y.所有患者随访升主动脉内径较术后存在扩张(36.6±4.8mm vs. 35.5±4.6mm,p=0.014),其中二瓣化组(37.0±5.0mm vs.35.5±4.6mm,p=0.009),非二瓣化组(36.1±4.7m vs.35.5±4.6mm=,p=0.188).结论对于主动脉瓣病变合并升主动脉扩张的患者,主动脉瓣置换同期行升主动脉成形术中期疗效安全可靠,二瓣化患者术后升主动脉较非二瓣化患者更易扩张,远期疗效仍需进行随访观察。
[Abstract]:Objective to analyze the mid-term clinical effect of ascending aortic angioplasty in the treatment of aortic valve disease with ascending aortic dilatation. Methods from January 2010 to December 2013, patients undergoing aortic valve replacement combined with ascending aortic angioplasty in our hospital due to aortic valve disease combined with ascending aortic dilatation were retrospectively analyzed. 102 patients were treated with aortic valve replacement combined with ascending aortic angioplasty. According to preoperative diagnosis and postoperative pathological results, 57 patients with aortic valve bivalvalization and 45 patients with non-bivalve aortic valve were divided into two groups. The mean age of the patients was 52.7 卤12.9 years. The mean age of the patients was 52.7 卤12.9 years old. The mean preoperative cardiac function grade was 71.6% and 42.2%. The left ventricular end-diastolic diameter was 56.9 卤9.1 mm, the ejection fraction was 61.3% 卤8.9 mm, the preoperative aortic sinus diameter was 35.9 卤5.3 mm, and the preoperative ascending aortic diameter was 45.6 卤4.9 mm. The outcome events were postoperative death, reoperation, stroke, aortic adverse events (dissection, rupture). Results the mean follow-up time was 38.8 卤13.0 months. There was a significant difference in age between the two groups (49.5 卤13.5 years old vs. in the two-valvular group). There were more patients with mitral valve disease (p0.01) and tricuspid insufficiency (p0.01) in the non-bivalvalization group than in the two-valvuloplasty group (p0.01). The preoperative left atrial diameter in the double-valvular group was significantly lower than that in the non-bicuspid valve group (p0.004), and that in the bicuspid group was significantly lower than that in the non-bicuspid valve group (p0.01). In the valvular group, the diameter of ascending aorta was larger than that of 45mm (p0. 004), and the other baseline data were comparable. There were 2 cases of postoperative death, 1 case of stroke, no reoperation and adverse events of aorta. The left atrial diameter, left ventricular end-diastolic diameter, aortic sinus diameter and ascending aortic diameter were significantly decreased in all patients (p0.001). The mean degree of aortic dilatation was 0.39 卤0.26 cm and the average aortic diameter dilation rate was 1.3 卤0.8 mm / y in all patients who were followed up with ascending aortic diameter compared with postoperative dilatation. All patients were followed up with dilatation of the ascending aorta (36.6 卤4.8mm vs. 35.5 卤4.6 mm, p0.014), including the double-valved group (37.0 卤5.0mm vs.35.5 卤4.6 mm, p0.009) and the non-double-valved group (36.1 卤4.7 m vs.35.5 卤4.6 mm vs.35.5, 0.188). Conclusion for patients with aortic valve disease combined with ascending aortic dilatation, aortic valve replacement combined with ascending aortic angioplasty is safe and reliable in the middle stage, and the ascending aorta is more easily dilated in patients with double valve replacement than in patients with non-bivalvolution. The long-term effect still needs to be followed up.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R654.2
[Abstract]:Objective to analyze the mid-term clinical effect of ascending aortic angioplasty in the treatment of aortic valve disease with ascending aortic dilatation. Methods from January 2010 to December 2013, patients undergoing aortic valve replacement combined with ascending aortic angioplasty in our hospital due to aortic valve disease combined with ascending aortic dilatation were retrospectively analyzed. 102 patients were treated with aortic valve replacement combined with ascending aortic angioplasty. According to preoperative diagnosis and postoperative pathological results, 57 patients with aortic valve bivalvalization and 45 patients with non-bivalve aortic valve were divided into two groups. The mean age of the patients was 52.7 卤12.9 years. The mean age of the patients was 52.7 卤12.9 years old. The mean preoperative cardiac function grade was 71.6% and 42.2%. The left ventricular end-diastolic diameter was 56.9 卤9.1 mm, the ejection fraction was 61.3% 卤8.9 mm, the preoperative aortic sinus diameter was 35.9 卤5.3 mm, and the preoperative ascending aortic diameter was 45.6 卤4.9 mm. The outcome events were postoperative death, reoperation, stroke, aortic adverse events (dissection, rupture). Results the mean follow-up time was 38.8 卤13.0 months. There was a significant difference in age between the two groups (49.5 卤13.5 years old vs. in the two-valvular group). There were more patients with mitral valve disease (p0.01) and tricuspid insufficiency (p0.01) in the non-bivalvalization group than in the two-valvuloplasty group (p0.01). The preoperative left atrial diameter in the double-valvular group was significantly lower than that in the non-bicuspid valve group (p0.004), and that in the bicuspid group was significantly lower than that in the non-bicuspid valve group (p0.01). In the valvular group, the diameter of ascending aorta was larger than that of 45mm (p0. 004), and the other baseline data were comparable. There were 2 cases of postoperative death, 1 case of stroke, no reoperation and adverse events of aorta. The left atrial diameter, left ventricular end-diastolic diameter, aortic sinus diameter and ascending aortic diameter were significantly decreased in all patients (p0.001). The mean degree of aortic dilatation was 0.39 卤0.26 cm and the average aortic diameter dilation rate was 1.3 卤0.8 mm / y in all patients who were followed up with ascending aortic diameter compared with postoperative dilatation. All patients were followed up with dilatation of the ascending aorta (36.6 卤4.8mm vs. 35.5 卤4.6 mm, p0.014), including the double-valved group (37.0 卤5.0mm vs.35.5 卤4.6 mm, p0.009) and the non-double-valved group (36.1 卤4.7 m vs.35.5 卤4.6 mm vs.35.5, 0.188). Conclusion for patients with aortic valve disease combined with ascending aortic dilatation, aortic valve replacement combined with ascending aortic angioplasty is safe and reliable in the middle stage, and the ascending aorta is more easily dilated in patients with double valve replacement than in patients with non-bivalvolution. The long-term effect still needs to be followed up.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R654.2
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