Walther T, Falk V, Langebartels G, Krüger M, Bernhardt U, Diegeler A, Gummert J, Autschbach R, Mohr F W
University Leipzig, Heartcenter, Department of Cardiac Surgery, Leipzig, Germany.
Circulation. 1999 Nov 9;100(19 Suppl):II6-10. doi: 10.1161/01.cir.100.suppl_2.ii-6.
The aim of this prospectively randomized study was to evaluate left ventricular hypertrophy and its regression after stentless versus conventional biological aortic valve replacement.
From March 1996 through April 1998, 180 patients were prospectively selected; 106 patients received a stentless aortic valve (SAV), and 74 received a conventional stented bioprosthesis (CSB). Of these patients, 95% and 96%, respectively, had aortic stenosis. Their mean age was 72.3 and 74.8 years, and there were no significant differences in left ventricular function, preoperative pressure gradients, and NYHA functional status. Aortic annulus diameter indexes were comparable at 13.46 (SAV) versus 13.55 (CSB) mm (P=NS). Larger SAVs were implanted because of the oversizing technique. In-hospital mortality (n=3 and 1 for SAV and CSB) was not valve related. At follow-up, all patients were in NYHA class 1 or 2. Baseline end-diastolic left ventricular posterior wall thickness was 15.6 (SAV) and 14.8(CSB) mm (P=NS) and decreased to 11. 8 (SAV) and 13.2 (CSB) mm (P<0.05) at 6 months. Left ventricular mass index was 213 and 202 g/m(2) at baseline (P=NS), whereas after 6 months, it was 141 (SAV) and 170 (CSB) g/m(2) (P<0.05).
Regression of left ventricular hypertrophy occurs in all patients after aortic valve replacement but is significantly enhanced after SAV implantation. This possibly is due to improved transvalvular hemodynamics.
本前瞻性随机研究的目的是评估无支架与传统生物主动脉瓣置换术后左心室肥厚及其逆转情况。
1996年3月至1998年4月，前瞻性选取180例患者；106例患者接受无支架主动脉瓣（SAV）置换，74例接受传统带支架生物瓣膜（CSB）置换。这些患者中，分别有95%和96%患有主动脉瓣狭窄。他们的平均年龄分别为72.3岁和74.8岁，左心室功能、术前压力阶差和纽约心脏协会（NYHA）心功能分级无显著差异。主动脉瓣环直径指数在SAV组为13.46mm，CSB组为13.55mm，具有可比性（P=无显著性差异）。由于采用了加大尺寸技术，植入了更大的SAV。住院死亡率（SAV组3例，CSB组1例）与瓣膜无关。随访时，所有患者的心功能分级均为NYHA 1级或2级。基线舒张末期左心室后壁厚度在SAV组为15.6mm，CSB组为14.8mm（P=无显著性差异），6个月时分别降至11.8mm（SAV组）和13.2mm（CSB组）（P<0.05）。左心室质量指数在基线时分别为213g/m²（SAV组）和202g/m²（CSB组）（P=无显著性差异），而6个月后，SAV组为141g/m²，CSB组为170g/m²（P<0.05）。
主动脉瓣置换术后所有患者的左心室肥厚均会发生逆转，但在植入SAV后逆转更为显著。这可能是由于跨瓣血流动力学得到改善。
