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首页> 外文期刊>Circulation journal >Early Surgery vs. Surgery After Watchful Waiting for Asymptomatic Severe Aortic Stenosis
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Early Surgery vs. Surgery After Watchful Waiting for Asymptomatic Severe Aortic Stenosis

机译：警惕等待无症状严重主动脉瓣狭窄后的早期手术与手术

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Background: There is no large-scale study comparing postoperative mortality after aortic valve replacement (AVR) for asymptomatic severe aortic stenosis (AS) between initial treatment with AVR vs. eventual AVR after conservative management. Methods?and?Results: We analyzed data from a multicenter registry enrolling 3,815 consecutive patients with severe AS. Of 1,808 asymptomatic patients, 286 patients initially underwent AVR (initial AVR group), and 377 patients were initially managed conservatively and eventually underwent AVR (AVR after watchful waiting group). Mortality after AVR was compared between the 2 groups. Subgroup analysis according to peak aortic jet velocity (Vmax) at diagnosis was also conducted. There was no significant difference between the 2 groups in 5-year overall survival (OS; 86.0% vs. 84.1%, P=0.34) or cardiovascular death-free survival (DFS; 91.3% vs. 91.1%, P=0.61), but on subgroup analysis of patients with Vmax ≥4.5 m/s at diagnosis, the initial AVR group was superior to the AVR after watchful waiting group in both 5-year OS (88.4% vs. 70.6%, P=0.003) and cardiovascular DFS (91.9% vs. 81.7%, P=0.023). Conclusions: Asymptomatic severe AS patients who underwent AVR after watchful waiting had a postoperative survival rate similar to those who initially underwent AVR. In a subgroup of patients with Vmax ≥4.5 m/s at diagnosis, however, the AVR after watchful waiting group had worse postoperative survival rate than the initial AVR group.
机译：背景：目前尚无大规模的研究比较初始治疗与保守治疗后无症状的主动脉瓣置换术（AVR）与无症状的严重主动脉瓣狭窄（AS）之间的术后死亡率。方法和结果：我们分析了来自一个多中心登记处的数据，该数据招募了3,815名连续的严重AS患者。在1,808名无症状患者中，有286例最初接受了AVR（初始AVR组），并且有377例患者最初接受了保守治疗，最后接受了AVR（观察组之后的AVR）。比较两组之间的AVR死亡率。还根据诊断时的主动脉峰值流速（Vmax）进行了亚组分析。两组的5年总生存率（OS; 86.0％vs. 84.1％，P = 0.34）或心血管无死亡生存率（DFS; 91.3％vs. 91.1％，P = 0.61）均无显着差异，但在诊断时Vmax≥4.5m / s的患者进行亚组分析时，在5年OS（88.4％vs. 70.6％，P = 0.003）和心血管DFS中，初始AVR组优于观察组后的AVR （91.9％对81.7％，P = 0.023）。结论：无症状的重度AS患者经过观察等待后接受AVR，其术后生存率与最初接受AVR的患者相似。然而，在诊断时Vmax≥4.5m / s的亚组患者中，观察等待组后的AVR的术后生存率较初始AVR组差。

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