Long-term durability of bioprosthetic aortic valves: implications from 12,569 implants.
Long-term durability of bioprosthetic aortic valves: implications from 12,569 implants.
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DOI：
10.1016/j.athoracsur.2014.10.070
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发表时间：
2015-04
影响因子：
4.6
通讯作者：
Blackstone, Eugene H.
中科院分区：
文献类型：
--
作者：
Johnston, Douglas R.;Soltesz, Edward G.;Vakil, Nakul;Rajeswaran, Jeevanantham;Roselli, Eric E.;Sabik, Joseph F., III;Smedira, Nicholas G.;Svensson, Lars G.;Lytle, Bruce W.;Blackstone, Eugene H.
预期寿命的增加和年轻患者避免终身抗凝的愿望需要更好地了解生物瓣膜失效。本研究评价了Carpentier-Edwards PERIMOUNT主动脉瓣（AV）长期系列中与结构性瓣膜退化（SVD）相关的风险因素。从1982年6月至2011年1月，12，569例患者使用Edwards Lifesciences Carpentier-Edwards PERIMOUNT带支架牛心包瓣膜（型号2700 PM（n = 310）或2700（n = 12，259））进行了AV置换术。平均年龄为71 ± 11岁（范围：18 - 98岁）。93%患有自体AV疾病，48%接受了同期冠状动脉旁路移植术，26%接受了额外的瓣膜手术。有81，706患者-年的系统随访数据可供分析。使用人口统计学、术中变量和27，386个超声心动图记录识别瓣膜SVD取出的风险，并使用时变协变量分析评估跨瓣压差的纵向变化。进行了354例取出，其中41%与心内膜炎相关，44%与SVD相关。10年和20年时瓣膜SVD取出的精算估计值分别为1.9%和15%，60岁以下患者分别为5.6%和46%。年龄较小（p <0.0001）、降脂药物（p = 0.002）、假体-患者不匹配（p = 0.001）以及术后峰值和平均AV压差较高与瓣膜SVD取出相关（p <0.0001）。在60岁以下的患者中，梯度对SVD的影响最大。即使在年轻患者中，Carpentier-Edwards PERIMOUNT主动脉瓣的耐久性也非常出色。SVD的取出与植入时的压差相关，尤其是在年轻患者中。应考虑降低术后早期AV梯度的策略，如根扩大或更有效的假体。
Increased life expectancy and younger patients’ desire to avoid lifelong anticoagulation requires a better understanding of bioprosthetic valve failure. This study evaluates risk factors associated with explantation for structural valve deterioration (SVD) in a long-term series of Carpentier-Edwards PERIMOUNT aortic valves (AV). From June 1982 to January 2011, 12,569 patients underwent AV replacement with Edwards Lifesciences Carpentier-Edwards PERIMOUNT stented bovine pericardial prostheses, models 2700PM (n = 310) or 2700 (n = 12,259). Mean age was 71 ± 11 years (range, 18 to 98 years). 93% had native AV disease, 48% underwent concomitant coronary artery bypass grafting, and 26% had additional valve surgery. There were 81,706 patient-years of systematic follow-up data available for analysis. Demographics, intraoperative variables, and 27,386 echocardiographic records were used to identify risks for explant for SVD and assess longitudinal changes in transprosthesis gradients using time-varying covariable analyses. Three hundred fifty-four explants were performed, with 41% related to endocarditis and 44% to SVD. Actuarial estimates of explant for SVD at 10 and 20 years were 1.9% and 15% overall, respectively, and in patients younger than 60 years, 5.6% and 46%, respectively. Younger age (p < 0.0001), lipid-lowering drugs (p = 0.002), prosthesis–patient mismatch (p = 0.001), and higher postoperative peak and mean AV gradients were associated with explant for SVD (p < 0.0001). The effect of gradient on SVD was greatest in patients younger than 60 years. Durability of the Carpentier-Edwards PERIMOUNT aortic valve is excellent even in younger patients. Explant for SVD is related to gradient at implantation, especially in younger patients. Strategies to reduce early postoperative AV gradients, such as root enlargement or more efficient prostheses, should be considered.
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影响因子：
3.7
作者：
BLACKSTONE, EH;NAFTEL, DC;TURNER, ME
通讯作者：
TURNER, ME
影响因子：
2
作者：
SAUERBREI, W;SCHUMACHER, M
通讯作者：
SCHUMACHER, M
影响因子：
4.6
作者：
Banbury, MK;Cosgrove, DM;Frater, RM
通讯作者：
Frater, RM
影响因子：
4.6
作者：
Banbury, MK;Cosgrove, DM;Okies, JE
通讯作者：
Okies, JE
影响因子：
6
作者：
Blackstone, EH
通讯作者：
Blackstone, EH