升主動脈成形術治療主動脈瓣病變合并升主動脈擴張的中期療效分析
發(fā)布時間：2018-10-14 15:40
【摘要】：目的分析升主動脈成形術治療主動脈瓣病變合并升主動脈擴張的中期臨床療效。方法回顧性地分析2010年1月至2013年12月因主動脈瓣病變合并升主動脈擴張于我院行主動脈瓣置換術合并升主動脈成形術的患者。入組患者102例,所有患者均接受主動脈瓣置換術合并升主動脈成形術,按照術前診斷及術后病理結果將主動脈瓣二瓣化患者(57例)和主動脈瓣非二瓣化患者(45例)分組進行分析�；颊咂骄挲g為52.7±12.9歲,男性患者占71.6%,42.2%術前心功能分級大于2級,術前左心室舒張末徑為56.9±9.1mm,射血分數(shù)為61.3%±8.9%,術前主動脈竇部內徑為35.9±5.3mm,術前升主動脈內徑為45.6±4.9mm。結局事件為術后死亡、再次手術、腦卒中、主動脈不良事件(夾層、破裂)。結果對所有入組患者術后隨訪資料進行分析,平均隨訪時間為38.8±13.0月。兩組患者在年齡上存在統(tǒng)計學差異(二瓣化組49.5±13.5歲vs.非二瓣化組56.8±10.9歲,P=0.004),非二瓣化組較二瓣化組有更多患者合并二尖瓣病變(p0.01)及合并三尖瓣關閉不全(p0.01),術前左心房內徑二瓣化組明顯小于非二瓣化組(p=0.004),二瓣化組較非二瓣化組有更多患者術前升主動脈內徑大于45mm(p=0.004),其余基線資料均具有可比性。術后死亡2例,腦卒中1例,無再次手術及發(fā)生主動脈不良事件患者。所有患者術后左心房內徑、左室舒張末期內徑、主動脈竇部內徑、升主動脈內徑均較術前明顯減小(p0.001)。所有隨訪升主動脈內徑較術后擴張的患者平均主動脈擴張程度為0.39±0.26cm,平均主動脈內徑擴張速率為1.3±0.8mm/y.所有患者隨訪升主動脈內徑較術后存在擴張(36.6±4.8mm vs. 35.5±4.6mm,p=0.014),其中二瓣化組(37.0±5.0mm vs.35.5±4.6mm,p=0.009),非二瓣化組(36.1±4.7m vs.35.5±4.6mm=,p=0.188).結論對于主動脈瓣病變合并升主動脈擴張的患者,主動脈瓣置換同期行升主動脈成形術中期療效安全可靠,二瓣化患者術后升主動脈較非二瓣化患者更易擴張,遠期療效仍需進行隨訪觀察。
[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 鹵12.9 years. The mean age of the patients was 52.7 鹵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 鹵9.1 mm, the ejection fraction was 61.3% 鹵8.9 mm, the preoperative aortic sinus diameter was 35.9 鹵5.3 mm, and the preoperative ascending aortic diameter was 45.6 鹵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 鹵13.0 months. There was a significant difference in age between the two groups (49.5 鹵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 鹵0.26 cm and the average aortic diameter dilation rate was 1.3 鹵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 鹵4.8mm vs. 35.5 鹵4.6 mm, p0.014), including the double-valved group (37.0 鹵5.0mm vs.35.5 鹵4.6 mm, p0.009) and the non-double-valved group (36.1 鹵4.7 m vs.35.5 鹵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.
【學位授予單位】：北京協(xié)和醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：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 鹵12.9 years. The mean age of the patients was 52.7 鹵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 鹵9.1 mm, the ejection fraction was 61.3% 鹵8.9 mm, the preoperative aortic sinus diameter was 35.9 鹵5.3 mm, and the preoperative ascending aortic diameter was 45.6 鹵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 鹵13.0 months. There was a significant difference in age between the two groups (49.5 鹵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 鹵0.26 cm and the average aortic diameter dilation rate was 1.3 鹵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 鹵4.8mm vs. 35.5 鹵4.6 mm, p0.014), including the double-valved group (37.0 鹵5.0mm vs.35.5 鹵4.6 mm, p0.009) and the non-double-valved group (36.1 鹵4.7 m vs.35.5 鹵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.
【學位授予單位】：北京協(xié)和醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R654.2
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