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左心室体积指数作为隔离性大动脉置换手术中的风险预测指标:来自多中心大动脉置换注册表的结果

Kazuma Handa¹, Koichi Maeda¹, Kyongsun Pak²

¹Department of Cardiovascular Surgery, The University of Osaka Graduate School of Medicine, Osaka, Japan.

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery

|January 12, 2026

概括

在接受为严重大动脉狭窄而进行大动脉置换手术的患者中,手术前的左心房扩大与心脏死亡率和心力衰竭的增加有关. 在左心房显著扩大之前的早期干预可以改善患者的治疗结果.

科学领域:

心脏病学心脏病学
心脏外科手术心脏外科手术
心声回声图 (Echocardiography) 是一种心声回声图.

背景情况:

大动脉狭窄症 (AS) 会导致左心室静脉功能障碍和相关的左心房功能障碍.
在接受AS外科手术的患者中,LA功能障碍的预后意义尚未得到充分确立.

研究的目的:

调查手术前左心房扩大对严重AS的隔离性大动脉置换手术 (SAVR) 后结果的预后影响.

主要方法:

分析了366名患有严重AS的患者队列,这些患者在2016年至2021年期间接受了分离的SAVR.
患者根据手术前的左心房体积指数 (LAVI) ≥40mL/m2进行了分层,定义了LA扩大.
五年后的结果,包括心脏病死亡率,全因死亡率和心力衰竭再入院,在各组之间进行了比较.

主要成果:

在手术前LA扩大 (LAVI ≥40mL/m2) 患者心脏病死亡率 (13.4%对2.6%),所有原因死亡率 (17.4%对7.6%) 和心力衰竭再入院率 (11.0%对2.8%) 在5年内显著上升.
手术前的LA扩大被确定为心脏死亡率的独立预测因子 (调整HR,2.08;P=0.041).
拉动脉扩大组也表现出较低的eGFR,血清白蛋白和射出分数,心房的倾向更高,STS-PROM更高.

结论:

在手术前的左心房扩大 (LAVI ≥40mL/m2) 与中期不良结果相关,包括死亡率和心力衰竭,在接受单独SAVR治疗严重AS的患者中.
这些发现表明,在左心房显著扩大之前进行大动脉置换手术可能会改善预后.

关键词:

大动脉门的更换左心房体积指数是左心房体积指数.最佳的外科手术时间.

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