O'Brien M F, Gardner M A, Garlick R B, Davison M B, Thomson H L, Burstow D J
The Department of Cardiac Surgery, The Prince Charles Hospital, Brisbane, Australia.
J Card Surg. 1998 Sep-Oct;13(5):376-85. doi: 10.1111/j.1540-8191.1998.tb01100.x.
The advantageous design of the Cryolife-O'Brien stentless porcine aortic valve permits specific quick, easy, supravalvular implantation using single layer continuous 3-0 polypropylene suture. The advantages, contraindications, and implantation errors to avoid are detailed. The use of this valve for aortic valve replacement in the elderly population has been directed to proving its efficacy and establishing its grounds for durability while maintaining all of the advantages of a stentless tissue valve.
From December 1992 to September 1998, this valve was used in 240 patients (mean age 73 years: 15% > 80 years), 45% receiving associated coronary artery grafting (2.4 grafts per patient). Left ventricular (LV) myomectomy was necessary in 12% of patients. Detailed postoperative follow-up (100%) analysis included 650 serial echocardiographic studies.
The 30-day mortality was low at 1.2% (3 deaths of 240 elderly patients). Ten patients had late mortality (1.5 months to 5 years), all nonvalve related. No structural failure and one only explant for endocarditis have occurred. Echocardiographic analyses have shown low mean transvalvular gradients in relationship to time (8.18 mmHg at 18 months) and to valve size (8.52 mmHg for a 23-mm host aortic annulus). Incompetence has been zero or a trace in 97% of the patients at 21/2 years. No patient over the 6 years shows valve deterioration.
Six years of experience with this stentless valve in 240 elderly patients has revealed the many advantages of this safe, composite, and truly stentless device that is assembled without the need for Dacron support. Excellent sustained hemodynamics with low gradients, minimal regurgitation, and a good effective orifice have been coupled with low immediate mortality, no intrinsic valve failure, and one explant for endocarditis. Marked LV regression and minimal late valve-related complications confirm the safety and advantages of this stentless valve.
Cryolife - O'Brien无支架猪主动脉瓣的优势设计允许使用单层连续3 - 0聚丙烯缝线进行特定的快速、简便的瓣上植入。详细介绍了其优势、禁忌证以及需避免的植入错误。在老年人群中使用这种瓣膜进行主动脉瓣置换旨在证明其疗效并确立其耐久性依据，同时保留无支架组织瓣膜的所有优势。
1992年12月至1998年9月，该瓣膜应用于240例患者（平均年龄73岁，15%年龄大于80岁），45%的患者接受了相关冠状动脉搭桥术（每位患者平均2.4支血管）。12%的患者需要进行左心室心肌切除术。详细的术后随访（100%）分析包括650次连续超声心动图检查。
30天死亡率较低，为1.2%（240例老年患者中有3例死亡）。10例患者出现晚期死亡（1.5个月至5年），均与瓣膜无关。未发生结构故障，仅1例因心内膜炎而取出瓣膜。超声心动图分析显示，与时间相关的平均跨瓣压差较低（18个月时为8.18 mmHg），与瓣膜尺寸相关的平均跨瓣压差也较低（对于23 mm的宿主主动脉瓣环，为8.52 mmHg）。在2.5年时，97%的患者反流为零或微量。6年内无患者出现瓣膜退化。
对240例老年患者使用这种无支架瓣膜的6年经验表明，这种安全、复合且真正无支架的装置无需涤纶支撑即可组装，具有诸多优势。低压差、极少反流和良好的有效瓣口面积所带来的出色持续血流动力学表现，与低早期死亡率、无瓣膜固有故障以及1例因心内膜炎取出瓣膜的情况相结合。左心室明显缩小以及极少的晚期瓣膜相关并发症证实了这种无支架瓣膜的安全性和优势。
