肥厚型梗阻性心肌病合并主动脉瓣狭窄患者手术治疗术中配合实践与效果分析OA

Objective To conduct a retrospective analysis of the intraoperative coordination essentials and perioperative efficacy analysis for patients with hypertrophic obstructive cardiomyopathy(HOCM)complicated with aortic stenosis(AS),and to provide reference for optimizing surgical decisions and improving patient prognosis.Methods We evaluated the surgical outcomes of 39 patients with HOCM complicated with AS who underwent surgical treatment in Beijing Anzhen Hospital affiliated to Capital Medical University from December 2019 to December 2025.The evaluation encompassed preoperative assessment,surgical preparation,intraoperative coordination,and perioperative efficacy.The median age of the 39 patients was 60.00 years(55.50,67.00),with 24 females(61.54％)and 13 patients with NYHA functional class III or above(33.33％).Among them,22 patients underwent aortic valve replacement(AVR)combined with the modified Morrow procedure(combined surgery group),and 17 patients underwent AVR alone(simple AVR group).Results All 39 patients successfully underwent surgery.The cardiopulmonary bypass time was longer in the combined surgery group than in the simple AVR group,at[158.00(127.25,179.50)]minutes and[129.00(120.00,140.00)minutes],respectively(P=0.032).The ascending aortic cross-clamping time was longer in the combined surgery group than in the simple AVR group,at[114.00(89.25,133.50)]minutes and[88.00(83.00,107.00)minutes],respectively(P=0.035).All surgeries in the entire cohort were successfully completed,and there were no indications for reoperation during intraoperative color Doppler echocardiography.Perioperative adverse events were generally rare,with 1 case of new-onset atrial fibrillation in the combined surgery group and 1 case of ischemic stroke in the simple AVR group.Two patients in the combined surgery group died early postoperatively,due to septic shock and cardiogenic shock with acute kidney injury,respectively;whereas there were no perioperative deaths in the simple AVR group.None of the patients had severe conduction block or required permanent pacemaker implantation.Conclusions For HOCM combined with AS patients,the"one incision,multi-step"surgical approach,coupled with the pathological characteristics of significant left ventricular hypertrophy and low hemodynamic reserve,preoperative adequate preparation,intraoperative precise and coordinated cooperation,and postoperative focused monitoring throughout the perioperative period are key to ensuring the smooth implementation of surgery and achieving good short-term outcomes.