Westaby S
Oxford Heart Centre, the John Radcliffe Hospital, Headington, Oxford, UK.
Semin Thorac Cardiovasc Surg. 2001 Jul;13(3):273-82. doi: 10.1053/stcs.2001.22991.
The availability of aortic homografts is steadily decreasing. In the meantime, stentless xenografts convey similar flow characteristics, and tissue preservation methods are improving durability. Initially, these valves were contraindicated in aortic roots with discrepancy between annulus and sinotubular junction or with extensive calcification or sepsis. With increasing experience stentless xenografts are now applied in a wide spectrum of aortic root disease.
I reviewed our own experience with stentless aortic bioprosthesis for aortic valve replacement (AVR) and more taxing root problems. I used these valves in aortic aneurysm repair, acute Type A dissection, and for endocarditis with abcess formation. I studied valve hemodynamics, regression of left ventricular hypertrophy, and comparative survival with stented bioprostheses.
Stentless bioprostheses convey hemodynamic and possibly survival benefit through a low incidence of valve-related complications. They provide a useful alternative to aortic homografts in endocarditis, Type A dissection, and aortic aneurysm surgery.
Stentless bioprostheses are no longer confined to AVR alone. Experience supports the use of stentless bioprostheses where aortic homografts were previously applied. With availability in a wide range of sizes.
主动脉同种异体移植物的可获得性正在稳步下降。与此同时，无支架异种移植物具有相似的血流特性，并且组织保存方法正在提高其耐久性。最初，这些瓣膜在瓣环与窦管交界处存在差异、有广泛钙化或感染的主动脉根部是禁忌使用的。随着经验的增加，现在无支架异种移植物被广泛应用于各种主动脉根部疾病。
我回顾了我们自己使用无支架主动脉生物假体进行主动脉瓣置换（AVR）以及处理更复杂根部问题的经验。我将这些瓣膜用于主动脉瘤修复、急性A型主动脉夹层以及伴有脓肿形成的心内膜炎。我研究了瓣膜血流动力学、左心室肥厚的消退情况以及与有支架生物假体的生存比较。
无支架生物假体通过较低的瓣膜相关并发症发生率带来血流动力学益处，可能还有生存益处。它们在感染性心内膜炎、A型主动脉夹层和主动脉瘤手术中为主动脉同种异体移植物提供了一种有用的替代方案。
无支架生物假体不再局限于单纯的主动脉瓣置换。经验支持在以前使用主动脉同种异体移植物的情况下使用无支架生物假体。其有多种尺寸可供选择。
