Maselli D, Pizio R, Bruno L P, Di Bella I, De Gasperis C
Department of Cardiac Surgery, Ospedale Maggiore della Carità, Novara, Italy.
Ann Thorac Surg. 1999 Apr;67(4):966-71. doi: 10.1016/s0003-4975(99)00215-5.
We studied the effect of four different types of prosthetic aortic valves on time course and extent of regression of left ventricular hypertrophy after aortic valve replacement for aortic stenosis.
Four groups of 10 patients each were randomly assigned to receive: (1) aortic homograft preserved in antibiotic solution at 4 degrees C, (2) Toronto stentless porcine valve, (3) Medtronic Freestyle stentless valve, or (4) Medtronic Intact aortic valve. The left ventricular mass index, effective orifice area index, and peak and mean transaortic gradients were measured by Doppler echocardiography before the operation and 8 months postoperatively.
The hemodynamic performance indices were much better for the homograft and stentless valves than for the stented one. The absolute left ventricular mass index reduction was greater in the homograft group compared with the Intact (p = 0.0004) and Toronto (p = 0.007) groups. The extent of percent left ventricular mass index reduction was greater only in the homograft group versus Intact group (p = 0.005). The multilinear regression analysis showed that the only predictors of a larger percentage of left ventricular mass index reduction were the homograft type, a higher valve size index, and a higher preoperative left ventricular mass index.
When a stentless or homograft aortic valve was used instead of a stented valve to replace a stenotic aortic valve there was more complete or at least faster regression of left ventricular hypertrophy. The hemodynamic performance of stentless porcine valves was similar to that of aortic homografts, nevertheless the aortic homografts preserved in antibiotic solution offered a faster regression of left ventricular hypertrophy during the same period of time.
我们研究了四种不同类型的人工主动脉瓣对主动脉瓣置换术后主动脉瓣狭窄患者左心室肥厚消退的时间进程和程度的影响。
将四组患者，每组10例，随机分配接受：（1）保存在4℃抗生素溶液中的主动脉同种异体移植物，（2）多伦多无支架猪瓣膜，（3）美敦力Freestyle无支架瓣膜，或（4）美敦力Intact主动脉瓣膜。术前及术后8个月通过多普勒超声心动图测量左心室质量指数、有效瓣口面积指数以及跨主动脉峰值和平均压差。
同种异体移植物瓣膜和无支架瓣膜的血流动力学性能指标比有支架瓣膜好得多。与Intact组（p = 0.0004）和多伦多组（p = 0.007）相比，同种异体移植物组的绝对左心室质量指数降低幅度更大。仅同种异体移植物组与Intact组相比，左心室质量指数降低百分比的幅度更大（p = 0.005）。多线性回归分析表明，左心室质量指数降低百分比更大的唯一预测因素是同种异体移植物类型、更高的瓣膜尺寸指数和更高的术前左心室质量指数。
当使用无支架或同种异体主动脉瓣膜替代有支架瓣膜来置换狭窄的主动脉瓣膜时，左心室肥厚的消退更完全或至少更快。无支架猪瓣膜的血流动力学性能与主动脉同种异体移植物相似，然而保存在抗生素溶液中的主动脉同种异体移植物在同一时间段内使左心室肥厚消退更快。
