Surgical Treatment of Aortic Regurgitation with Lower Ejection Fraction_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 LIXin-min , ZHUYan , ZHAOKe-yan , XIAPeng

Department of Cardiovascular Surgery, General Hospital of Shenyang Military Region, Shenyang 110016, P. R. China;

Corresponding author：

LIXin-min, Email: lixinmin33@hotmail.com

Keywords：

Aortic regurgitation; Lower ejection fraction; Valve replacement

DOI：

10.7507/1007-4848.20150167

Video：

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Objective To summarize the surgical experience of aortic regurgitation with lower ejection fraction (EF). Methods We retrospectively analyzed the clinical data of 34 patients with aortic regurgitation and lower ejection fraction received aortic valve replacement in the General Hospital of Shenyang Military Region between January 2012 and December 2013. There were 27 males and 7 females with age of 21-74 (51.03±12.06) years. All surgical procedures were performed under general anesthesia during cardiopulmonary bypass. Results There was no operative mortality. Cardiopulmonary bypass time was 40-155 (60.92±22.89) minutes, aortic clamping time varied from 24 to 79 (37.12±12.61) minutes. Postoperative ventilator-assisted time was 4 to 67 (16.12±12.74) hours. The patients were discharged 8-15 (11.03±2.04) days after surgery. When discharged, EF value was 30% to 48% (41%±4%) and significantly improved compared with that before operation (P<0.01). Pulmonary artery systolic pressure varied from 33 to 50 (38.35±4.35) mm Hg and decreased significantly than that before operation (P<0.01). Left ventricular end-diastolic volume reduced to 168-380 (269.12±52.01) ml and obviously decreased than that before operation (P<0.01). Conclusion Surgical treatment can be carried out on patients with aortic insufficiency and lower EF. Treatment results are satisfactory.

Citation： LIXin-min, ZHUYan, ZHAOKe-yan, XIAPeng. Surgical Treatment of Aortic Regurgitation with Lower Ejection Fraction. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(7): 657-659. doi: 10.7507/1007-4848.20150167 Copy

1.	Roberts WC, Vowels TJ, Ko JM. Natural history of adults with congenitally malformed aortic valves (unicuspid or bicuspid). Medicine, 2012, 91(6):287-308.
2.	胡盛寿, 张国平, 朱晓东, 等. 巨大心脏瓣膜置换手术后远期疗效的观察. 中华外科杂志, 1996, 34(3):164.
3.	Taniguchi K, Sawa Y. Contemporary reviews by surgeon:timing of operation for chronic aortic regurgitation. Gen Thorac Cardiovasc Surg, 2012, 60(11):735-743.
4.	徐激斌, 唐杨烽, 徐志云, 等. 主动脉瓣关闭不全合并左心室功能不全的外科治疗. 中国胸心血管外科临床杂志, 2011, 18(6):565-567.
5.	Pate R, Kamath A, Varadarajan P, et al. Slow rate of progression of grade 1 and 2+ aortic regurgitation. J Heart Valve Dis, 2012, 21(3):328-330.
6.	Maganti K, Rigolin VH, Sarano ME, et al. Valvular heart disease:diagnosis and management. Mayo Clin Proc, 2010, 85(5):483-500.
7.	Reginelli JP, Griffin B. The challenge of valvular heart disease:When is it time to operate? Cleve Clin J Med, 2004, 71(6):464-482.
8.	孙强, 张永善, 许运宾, 等. 心脏瓣膜病合并巨大左心室的外科治疗. 中国胸心血管外科临床杂志, 2005, 12(3):226.
9.	Park HW, Song JM, Choo SJ, et al. Effect of preoperative ejection fraction, left ventricular systolic dimension and hemoglobin level on survival after aortic valve surgery in patients with severe chronic aortic regurgitation. Am J Cardiol, 2012, 109(12):1782-1786.
10.	朱团结, 姚筱, 廖凡, 等. 大左心室心脏病患者术后发生室性心律失常的危险因素分析. 中国胸心血管外科临床杂志, 2009, 16(2):110-113.
11.	于伟勇, 张宝仁, 侯明君, 等. 二尖瓣置换术后巨大左室的几何形态学变化及其与左室收缩功能的关系. 中华胸心血管外科杂志, 2002, 18(5):267-270.
12.	邱志兵, 陈鑫, 徐明, 等. 巨大左心室心脏瓣膜置换术后左心室重构的临床观察. 中国胸心血管外科临床杂志, 2006, 13(3):155-157.
13.	覃俊安, 黄小龙, 吴西林, 等. 心脏瓣膜病合并巨大左心室的外科治疗疗效观察. 第四军医大学学报, 2008, 29(19):封3-01.
14.	于伟勇, 张宝仁, 梅举, 等. 巨大左心室患者心脏瓣膜手术的围术期特点及其处理. 第二军医大学学报, 1999, 20(12):1018-1020.
15.	Mokadam NA, Stout KK, Verrier ED. Management of acute regurgitation in left-sided cardiac valves. Tex Heart Inst J, 2011, 38(1):9-19.
16.	Ren X, Banki NM. Classic hemodynamic findings of severe aortic regurgitation. Circulation, 2012, 126(3):e28-e29.
17.	Hamirani YS, Diet CA, Voyles W, et al. Acute aortic regurgitation. Circulation, 2012, 126(9):1121-1126.
18.	Corti R, Binggeli C, Turina M, et al. Predictors of long-term survival after valve replacement for chronic aortic regurgitation. Is M-mode echocardiography sufficient? Eur Heart J, 2001, 22(10):866-873.

1. Roberts WC, Vowels TJ, Ko JM. Natural history of adults with congenitally malformed aortic valves (unicuspid or bicuspid). Medicine, 2012, 91(6):287-308.
2. 胡盛寿, 张国平, 朱晓东, 等. 巨大心脏瓣膜置换手术后远期疗效的观察. 中华外科杂志, 1996, 34(3):164.
3. Taniguchi K, Sawa Y. Contemporary reviews by surgeon:timing of operation for chronic aortic regurgitation. Gen Thorac Cardiovasc Surg, 2012, 60(11):735-743.
4. 徐激斌, 唐杨烽, 徐志云, 等. 主动脉瓣关闭不全合并左心室功能不全的外科治疗. 中国胸心血管外科临床杂志, 2011, 18(6):565-567.
5. Pate R, Kamath A, Varadarajan P, et al. Slow rate of progression of grade 1 and 2+ aortic regurgitation. J Heart Valve Dis, 2012, 21(3):328-330.
6. Maganti K, Rigolin VH, Sarano ME, et al. Valvular heart disease:diagnosis and management. Mayo Clin Proc, 2010, 85(5):483-500.
7. Reginelli JP, Griffin B. The challenge of valvular heart disease:When is it time to operate? Cleve Clin J Med, 2004, 71(6):464-482.
8. 孙强, 张永善, 许运宾, 等. 心脏瓣膜病合并巨大左心室的外科治疗. 中国胸心血管外科临床杂志, 2005, 12(3):226.
9. Park HW, Song JM, Choo SJ, et al. Effect of preoperative ejection fraction, left ventricular systolic dimension and hemoglobin level on survival after aortic valve surgery in patients with severe chronic aortic regurgitation. Am J Cardiol, 2012, 109(12):1782-1786.
10. 朱团结, 姚筱, 廖凡, 等. 大左心室心脏病患者术后发生室性心律失常的危险因素分析. 中国胸心血管外科临床杂志, 2009, 16(2):110-113.
11. 于伟勇, 张宝仁, 侯明君, 等. 二尖瓣置换术后巨大左室的几何形态学变化及其与左室收缩功能的关系. 中华胸心血管外科杂志, 2002, 18(5):267-270.
12. 邱志兵, 陈鑫, 徐明, 等. 巨大左心室心脏瓣膜置换术后左心室重构的临床观察. 中国胸心血管外科临床杂志, 2006, 13(3):155-157.
13. 覃俊安, 黄小龙, 吴西林, 等. 心脏瓣膜病合并巨大左心室的外科治疗疗效观察. 第四军医大学学报, 2008, 29(19):封3-01.
14. 于伟勇, 张宝仁, 梅举, 等. 巨大左心室患者心脏瓣膜手术的围术期特点及其处理. 第二军医大学学报, 1999, 20(12):1018-1020.
15. Mokadam NA, Stout KK, Verrier ED. Management of acute regurgitation in left-sided cardiac valves. Tex Heart Inst J, 2011, 38(1):9-19.
16. Ren X, Banki NM. Classic hemodynamic findings of severe aortic regurgitation. Circulation, 2012, 126(3):e28-e29.
17. Hamirani YS, Diet CA, Voyles W, et al. Acute aortic regurgitation. Circulation, 2012, 126(9):1121-1126.
18. Corti R, Binggeli C, Turina M, et al. Predictors of long-term survival after valve replacement for chronic aortic regurgitation. Is M-mode echocardiography sufficient? Eur Heart J, 2001, 22(10):866-873.

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