Abstract:Objective To investigate clinical characteristics of patients with aortic valve disease and coronary artery disease （CAD）， and improve the pertinence of clinical management. Methods Clinical data of 78 patients who were older than 50 years and underwent isolated aortic valve replacement （AVR） in General Hospital of Shenyang Command from January to October 2010. All the patients were divided into two groups according to whether they had CAD：20 patients with CAD in the CAD group， including 19 males and 1 female with their average age of 64.6±8.3 years， and 58 patients without CAD in the control group， including 28 males and 30 females with their average age of 58.7±6.2 years. Clinical characteristics of AVR patients with CAD were analyzed by one-way analysis of variance and multiple factor analysis. Results One-way analysis showed that the incidence of old age （P=0.000）， male patients （P=0.004）， diabetes （P=0.004）， aortic regurgitation （P=0.034）， valvular lesion （P=0.028）， and postoperative mechanical ventilation time （P=0.008）of CAD group patients were significantly higher or longer than those of control group patients. Multiple factor analysis showed that independent clinical characteristics of AVR patients with CAD included male patients， old age， prolonged postoperative mechanical ventilation time， significantly decreased pulmonary arterial systolic pressure （PASP） at 6th postoperative month， and significant preoperative right ventricular diastolic dysfunction. Conclusion The screening age for possible CAD should be reasonably lowered if male patients with aortic valve disease have concomitant preoperative right ventricular diastolic dysfunction and/or tricuspid aortic valve degeneration. Patients undergoing isolated AVR need to take medications to reverse left ventricular remodeling for a long time to avoid severe arrhythmia.
Citation：
JIN Yan,WANG Huishan,JIANG Hui,TAO Dengshun,WU Haibo,YU Yan.. Clinical Characteristics of Patients with Coronary Artery Disease Undergoing Isolated Aortic Valve Replacement. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2013, 20(1): 15-19. doi:
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Copyright © the editorial department of Chinese Journal of Clinical Thoracic and Cardiovascular Surgery of West China Medical Publisher. All rights reserved
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- 1. Banovic MD， Vujisic-Tesic BD， Kujacic VG， et al. Coronary flow reserve in patients with aortic stenosis and nonobstructed coronary arteries. Acta Cardiol， 2011， 66 （6）：743-749.
- 2. Nemes A， Balázs E， Csanády M， et al. Long-term prognostic role of coronary flow velocity reserve in patients with aortic valve stenosis -insights from the SZEGED Study. Clin Physiol Funct Imaging， 2009， 29 （6）：447-452.
- 3. Jassal DS， Tam JW， Bhagirath KM， et al. Association of mitral annular calcification and aortic valve morphology：a substudy of the aortic stenosis progression observation measuring effects of rosuvastatin （ASTRONOMER） study. Eur Heart J， 2008， 29 （12）：1542-1547.
- 4. Sgorbini L， Scuteri A， Leggio M， et al. Carotid intima-media thickness， carotid distensibility and mitral， aortic valve calcification：a useful diagnostic parameter of systemic atherosclerotic disease. J Cardiovasc Med （Hagerstown）， 2007， 8 （5）：342-347.
- 5. Nagueh SF， Appleton CP， Gillebert TC， et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. Eur J Echocardiogr， 2009， 10 （2）：165-193.
- 6. Rudski LG， Lai WW， Afilalo J， et al. CME exam for guidelines for the echocardiographic assessment of the right heart in adults：a report from the American Society of Echocardiography. J Am Soc Echocardiogr， 2010， 23 （7）：786-788.
- 7. Vahanian A， Baumgartner H， Bax J， et al. Guidelines on the management of valvular heart disease. Eur Heart J， 2007， 60 （6）：1e-50e.
- 8. Saxena A， Poh CL， Dinh DT， et al. Does patient gender affect outcomes after concomitant coronary artery bypass graft and aortic valve replacement? An Australian Society of Cardiac and Thoracic Surgeons Database study. Cardiology， 2011， 119 （2）：116-123.
- 9. 王吉耀， 廖二元， 胡品津， 主编. 内科学——供七年制临床医学专业用. 北京：人民卫生出版社， 2002. 246.
- 10. Alvarez JR， Sierra J， Vega M， et al. Early calcification of the aortic mitroflow pericardial bioprosthesis in the elderly. Interact Cardiovasc Thorac Surg， 2009， 9 （5）：842-846.
- 11. Roy S， Hawkins T， Bourke JP. The safety of dipyridamole-thallium imaging in patients with critical aortic valve stenosis and angina. Nucl Med Commun， 1998， 19 （8）：789-794.
- 12. 陈治奎， 姜庆军， 周军波， 等. 主动脉瓣钙化在冠心病诊断中的临床价值. 心脑血管病防治， 2009， 9 （5）：350-352.
- 13. 邵冲， 单月宏， 谢永明， 等. 主动脉瓣置换术127例临床分析. 中华全科医学， 2010， 8 （1）：34-35.
- 14. Gunay R， Sensoz Y， Kayacioglu I， et al. Is the aortic valve pathology type different for early and late mortality in concomitant aortic valve replacement and coronary artery bypass surgery?Interact Cardiovasc Thorac Surg， 2009， 9 （4）：630-634.
- 15. Koene BM， van Straten AH， van Geldorp MW， et al. Can the EuroSCORE predict midterm survival after aortic valve replacement ? J Cardiothorac Vasc Anesth， 2012， 26 （4）：617-623.
- 16. Dell'amore A， Aquino TM， Pagliaro M， et al. Aortic valve replacement with and without combined coronary bypass grafts in very elderly patients：early and long-term results. Eur J Cardiothorac Surg， 2012， 41 （3）：491-498.
- 17. de Waard GA， Jansen EK， de Mulder M， et al. Long-term outcomes of isolated aortic valve replacement and concomitant AVR and coronary artery bypass grafting. Neth Heart J， 2012， 20 （3）：110-117.
- 18. Vicchio M， Feo MD， Giordano S， et al. Coronary artery bypass grafting associated to aortic valve replacement in the elderly：survival and quality of life. J Cardiothorac Surg， 2012， 7：13.
- 19. Cho WC， Yoo DG， Kim JB， et al. Aortic valve replacement for aortic stenosis and concomitant coronary artery bypass：long-term outcomes and predictors of mortality. Kore J Thorac Cardiovasc Surg， 2011， 44 （2）：131-136.
