Stentless vs Stented Aortic Valve Bioprostheses in the Small Aortic Root.
Stentless vs Stented Aortic Valve Bioprostheses in the Small Aortic Root.
复制标题
小主动脉根部的无支架与带支架主动脉瓣生物假体。
DOI：
10.1053/j.semtcvs.2016.02.012
复制
发表时间：
2016
影响因子：
2.5
通讯作者：
B. D. de Mol
中科院分区：
文献类型：
--
作者：
L. Wollersheim;Wilson W. Li;A. Kaya;B. Bouma;A. Driessen;W. V. van Boven;J. van der Meulen;B. D. de Mol
对于主动脉根部较小的患者行主动脉瓣膜置换术(AVR)，Freedom Solo生物假体由于其无支架设计和环上植入，可能是理想的假体。这项研究调查了在主动脉根部较小的患者中，与有支架的生物假体相比，无支架Freedom SOLO是否具有优势。从2005年4月至2014年7月，连续269例患者接受了AVR，分别使用Freedom Solo(n=76)或Mitroflow(n=193)尺寸为19 mm或21 mm的生物假体。这项回顾性对比研究提供了临床和超声心动图随访数据。在结果上，手术结果和存活率相似。术后7年，再手术和瓣膜结构恶化的累积发生率分别为0%比7.1%(P=0.03)和0%比4.5%(P=0.08)。此外，术后瓣膜的最大压差和平均压差分别为21±9 mm Hgvs 32±12 mm Hg和12±5 mm Hgvs19±8 mm Hg，P均=0.001。在中期随访中，这种血流动力学优势继续有利于自由单人。此外，Freedom SOLO中假体与患者不匹配的发生率较低(28%比52%，P=0.001)。在人工瓣膜心内膜炎、血栓栓塞症或出血事件方面没有差异。总之，与有支架的Mitroflow生物假体相比，无支架Freedom SOLO在主动脉根部较小的患者的AVR中有几个显著的优势。Freedom SOLO显示出卓越的血流动力学性能，瓣膜梯度显著降低，并在中期随访期间保持稳定。此外，发生假体与患者不匹配的情况明显减少，Freedom SOLO显示出卓越的耐用性。
In patients with a small aortic root undergoing aortic valve replacement (AVR), the Freedom SOLO bioprosthesis may be the ideal prosthesis because of its stentless design and supra-annular implantation. This study investigated if the stentless Freedom SOLO has an advantage when compared with a stented bioprosthesis in patients with a small aortic root. From April 2005-July 2014, 269 consecutive patients underwent AVR with either a Freedom SOLO (n = 76) or Mitroflow (n = 193) bioprosthesis size 19mm or 21mm, respectively. This retrospective comparison study presents clinical and echocardiographic follow-up data. In results, operative outcome and survival were similar. At 7 years, cumulative incidence of aortic valve reoperation and structural valve deterioration favor the Freedom SOLO (0% vs 7.1%, P = 0.03 and 0% vs 4.5%, P = 0.08, respectively). Additionally, the postoperative peak and mean valvular gradients favor the Freedom SOLO (21 ± 9mmHg vs 32 ± 12mmHg and 12 ± 5mmHg vs 19 ± 8mmHg, both P = <0.001, respectively). During mid-term follow-up this hemodynamic advantage continued in favor of the Freedom SOLO. Also prosthesis-patient mismatch occurred less frequently in the Freedom SOLO (28% vs 52%, P = 0.001). There were no differences in prosthetic valve endocarditis, thromboembolic, or bleeding events. In conclusion, the stentless Freedom SOLO has several significant advantages for AVR in patients with a small aortic root in comparison with a stented Mitroflow bioprosthesis. The Freedom SOLO shows superior hemodynamic performance with significantly lower valvular gradients that remained stable during mid-term follow-up. Additionally, significantly fewer prosthesis-patient mismatch occurred and the Freedom SOLO showed superior durability.