The 17-mm St. Jude Medical Regent Valve Is a Valid Option for Patients With a Small Aortic Annulus
The 17-mm St. Jude Medical Regent Valve Is a Valid Option for Patients With a Small Aortic Annulus
复制标题
DOI：
10.1016/j.athoracsur.2008.09.051
复制
发表时间：
2009-01-01
影响因子：
4.6
通讯作者：
Adachi, Hideo
中科院分区：
文献类型：
--
作者：
Okamura, Homare;Yamaguchi, Atsushi;Adachi, Hideo
背景。当主动脉瓣环较小的患者进行主动脉瓣置换术时，假体与患者的不匹配是值得关注的问题。这种假体与患者的不匹配可能会影响术后临床状态和生存。我们调查了主动脉瓣狭窄患者使用 17 毫米机械假体进行孤立主动脉瓣置换术的结果。方法。 23 名主动脉瓣狭窄患者（平均年龄，74.6 +/- 6.3 岁）接受了使用 17 毫米 St. Jude Medical Regent 假体进行的孤立主动脉瓣置换术。平均体表面积为 1.41 +/- 0.13 m(2)。术前超声心动图显示平均主动脉瓣面积为 0.36 +/- 0.10 cm(2)/ m(2)，平均左心室-主动脉压力梯度为 68.4 +/- 25.3 mm Hg，平均左心室质量指数为 200 +/- 69 g/m(2)。 结果。没有手术死亡，也没有瓣膜相关事件。主动脉瓣置换术后 14.0 +/- 10.0 个月的超声心动图显示，平均有效孔口面积指数显着增加（0.95 +/- 0.24 cm(2)/m(2)），平均左心室-主动脉压力梯度下降（17.4 +/- 8.2 mm Hg），平均左心室质量指数下降（124 +/- 37）厘米(2)/米(2))。 8 名患者出院时存在假体与患者不匹配（有效孔口面积指数 < 0.85 cm(2)/m(2)）。在这些患者以及没有假体与患者不匹配的患者中，随访期间左心室质量指数显着下降。结论。使用 17 毫米 Regent 假体进行主动脉瓣置换似乎可以为主动脉环较小的患者提供令人满意的临床和血流动力学结果。无论出院时的有效孔口面积指数如何，随访期间左心室质量均显着下降。
Background. When aortic valve replacement is performed in patients with a small aortic annulus, prosthesis-patient mismatch is of concern. Such prosthesis-patient mismatch may affect postoperative clinical status and survival. We investigated the outcomes of isolated aortic valve replacement performed with a 17-mm mechanical prosthesis in patients with aortic stenosis.Methods. Twenty-three patients with aortic stenosis (mean age, 74.6 +/- 6.3 years) underwent isolated aortic valve replacement with a 17-mm St. Jude Medical Regent prosthesis. Mean body surface area was 1.41 +/- 0.13 m(2). Preoperative echocardiography yielded a mean aortic valve area of 0.36 +/- 0.10 cm(2)/ m(2), a mean left ventricular-aortic pressure gradient of 68.4 +/- 25.3 mm Hg, and a mean left ventricular mass index of 200 +/- 69 g/m(2).Results. There was no operative mortality, and there were no valve-related events. Echocardiography at 14.0 +/- 10.0 months after aortic valve replacement showed a significant increase in the mean effective orifice area index (0.95 +/- 0.24 cm(2)/m(2)), decrease in the mean left ventricular-aortic pressure gradient (17.4 +/- 8.2 mm Hg), and decrease in the mean left ventricular mass index (124 +/- 37 cm(2)/m(2)). Prosthesis-patient mismatch (effective orifice area index < 0.85 cm(2)/m(2)) was present in 8 patients at discharge. In these patients as well as in those without prosthesis-patient mismatch, the left ventricular mass index decreased remarkably during follow-up.Conclusions. Aortic valve replacement with a 17-mm Regent prosthesis appears to provide satisfactory clinical and hemodynamic results in patients with a small aortic annulus. Remarkable left ventricular mass regression during follow-up was achieved irrespective of the effective orifice area index at discharge.