主动脉瓣二叶畸形行主动脉瓣置换术后疗效的中期随访研究——基于倾向性评分匹配法分析

刘凌超; 唐富琴; 李畑波; 徐博; 刘宸铖; 肖颖彬; 王咏

doi:10.16016/j.1000-5404.202009112

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主动脉瓣二叶畸形行主动脉瓣置换术后疗效的中期随访研究——基于倾向性评分匹配法分析

心脏外科临床研究 | 更新时间：2026-01-09

- 主动脉瓣二叶畸形行主动脉瓣置换术后疗效的中期随访研究——基于倾向性评分匹配法分析
- Efficacy of aortic valve replacement for bicuspid aortic valve: a medium-term follow-up study based on propensity score matching analysis
- 第三军医大学学报 2021年43卷第2期页码：101-108
- 作者机构：
  
  400037 重庆，陆军军医大学(第三军医大学)第二附属医院全军心血管外科研究所
- 作者简介：
  
  [ 王咏，E-mail: wy003236@163.com WANG Yong, E-mail: wy003236@163.com
- 基金信息：
  
  重庆市社会事业与民生保障科技创新专项(CSTC2015shmszx120088)
- DOI：10.16016/j.1000-5404.202009112
  中图分类号： R181.23;R542.52;R654.2
- 收稿：2020-09-14，
  
  修回：2020-11-27，
  
  纸质出版：2021-01-30
- 稿件说明：
移动端阅览
刘凌超, 唐富琴, 李畑波, 等. 主动脉瓣二叶畸形行主动脉瓣置换术后疗效的中期随访研究——基于倾向性评分匹配法分析[J]. 第三军医大学学报, 2021,43(2):101-108.

Lingchao LIU, Fuqin TANG, Tianbo LI, et al. Efficacy of aortic valve replacement for bicuspid aortic valve: a medium-term follow-up study based on propensity score matching analysis[J]. Journal of Third Military Medical University, 2021, 43(2): 101-108.
刘凌超, 唐富琴, 李畑波, 等. 主动脉瓣二叶畸形行主动脉瓣置换术后疗效的中期随访研究——基于倾向性评分匹配法分析[J]. 第三军医大学学报, 2021,43(2):101-108. DOI： 10.16016/j.1000-5404.202009112.

Lingchao LIU, Fuqin TANG, Tianbo LI, et al. Efficacy of aortic valve replacement for bicuspid aortic valve: a medium-term follow-up study based on propensity score matching analysis[J]. Journal of Third Military Medical University, 2021, 43(2): 101-108. DOI： 10.16016/j.1000-5404.202009112.

摘要

目的

探讨主动脉瓣二叶畸形(bicuspid aortic valve

BAV)与三叶主动脉瓣(tricuspid aortic valve

TAV)患者行主动脉瓣机械瓣置换(aortic valve replacement，AVR)术后中期疗效差异及影响因素。

方法

回顾性分析2014年1月至2019年6月在陆军军医大学第二附属医院行AVR的245例患者临床资料，分为两组:TAV组，158例；BAV组，87例，其中0型Ap 15例，0型Lat 21例，1型45例，2型6例。采用1:1倾向性评分匹配法(propensity score matching method

PSM)筛选匹配队列并比较术中、围手术期及随访结局。多因素Logistic回归分析用于评估影响升主动脉继续扩张的因素。

结果

PSM筛选出了69对匹配队列并平衡了两组之间的基线差异(

0.05)。两组患者的术中及围手术期结局差异均无统计学意义。在45个月中位随访期间，两组升主动脉直径、主动脉窦部直径及其变化情况、主动脉不良事件发生率、人工瓣膜的功能状态及心功能分级差异均无统计学意义，而BAV组升主动脉变化差值、年变化率以及升主动脉继续扩张人数的比例均显著高于TAV组(

=0.016、0.010、0.041)。PSM队列经多因素Logistic回归分析显示，BAV分类(

=3.296，95%

: 1.473~7.372)、主动脉瓣单纯反流(

=6.491，95%

: 2.691~15.657)及主动脉瓣狭窄伴反流(

=8.233，95%

: 2.565~26.429)与AVR术后升主动脉继续扩张存在独立正相关。进一步在PSM队列中筛选出BAV队列，多因素Logistic回归分析显示，1型BAV分型(

=10.378，95%

: 1.587~67.853)、吸烟史(

=4.959，95%

: 1.158~21.231)以及主动脉瓣单纯反流(

=8.070，95%

: 1.729~37.674)与AVR术后升主动脉继续扩张存在独立正相关。

结论

BAV相较于TAV患者在AVR置换术后更容易发生升主动脉的继续扩张。1型BAV分型、吸烟史及主动脉瓣反流是BAV患者AVR术后升主动脉继续扩张的独立危险因素。

Abstract

Objective

To investigate the differences and factors influencing the medium-term outcomes of aortic valve replacement (AVR) between bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) patients.

Methods

A total of 245 patients who underwent AVR in our hospital from January 2014 to June 2019 and met our inclusion criteria were retrospectively recruited in this study

and were divided into TAV group (

=158) and BAV group (

=87)

including 15 cases of type 0 Ap

21 cases of type 0 Lat

45 cases of type 1

and 6 cases of type 2. The 1:1 propensity score matching method (PSM) was used to screen the matching cohort

and the intraoperative

perioperative and follow-up outcomes were compared. Multivariate Logistic regression analysis was performed to evaluate the factors affecting

the continued dilation of the ascending aorta.

Results

After PSM

69 pairs of matching cohorts were selected and the baseline data of the 2 groups were basically balanced. Intraoperative and perioperative outcomes did not differ between the 2 groups. During the median follow-up time of 45 months

there were no significant differences in the diameter of the ascending aorta

diameter of the aortic sinus and its changes

incidence of adverse aortic events

functional status of the prosthetic valve

and classification of cardiac function between the 2 groups

while the difference of ascending aorta change

annual change rate

and proportion of continuous dilation of ascending aorta were significantly higher in the BAV group than the TAV group (

=0.016

0.010

0.041). Multivariate Logistic regression analysis of PSM cohort showed that BAV types (

=3.296

95%

: 1.473~7.372)

aortic regurgitation (

=6.491

95%

: 2.691~15.657) and aortic valve stenosis with regurgitation (

=8.233

95%

: 2.565~26.429) were positively correlated with the continued dilatation of the ascending aorta after AVR. Furthermore

after the BAV cohort was screened out from the PSM cohort

multivariate Logistic regression analysis indicated that type 1 in BAV (

=10.378

95%

: 1.587~67.853)

smoking (

=4.959

95%

: 1.158~21.231) and aortic regurgitation (

=8.070

95%

: 1.729~37.674) were positively correlated with the continued dilatation of the ascending aorta after AVR in BAV patients.

Conclusion

BAV patients are more likely to continue to dilate the ascending aorta after AVR when compared with TAV patients

and type 1 in BAV

smoking and aortic regurgitation are independent risk factors in BAV patients.

关键词

Keywords

references

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