Jin X Y, Westaby S
Department of Cardiac Surgery, Oxford Heart Centre, Oxford Radcliffe Hospitals, Oxford, UK.
Semin Thorac Cardiovasc Surg. 2001 Oct;13(4 Suppl 1):55-9.
The objective of this study was to determine the effects of sizing policy for pericardial stentless valves on hemodynamic performance and aortic root geometry. Discharge echocardiography was performed on 103 patients out of 110 consecutive implants (54 men and 49 women, mean age 75 +/- 9 years, and 36% with Co-CABG). Valve prosthesis size was based on largest annulus size plus 1 to 2 mm in the first 50 implants (group A, n = 48). Following continuous echo assessment, sizing policy was changed to annulus size plus 3 to 4 mm in the next 60 implants (group B, n = 55). Sinotubular (ST) junction was kept within 115% of the annulus size by surgical remodeling of aortic root. In comparison with group A, group B had a 7% larger valve size (25.2 +/- 2.1 mm v 23.6 +/- 2.3, mm, P <.01) implanted for patients of same body surface area and left ventricular cavity size. However, group B has a 38% lower mean pressure gradient (4.0 +/- 2.7 v 6.5 +/- 3.2, mm Hg, P <.01), a 32% greater effective orifice area (2.3 +/- 0.9 cm(2) v 1.7 +/- 0.7 cm(2), P <.01), better root distensibility (9.3% +/- 6.0% v 6.8% +/- 4.1%, P =.026), and a lower ratio of ST junction to valve size (0.92 +/- 0.13 v 0.99 +/- 0.14, P =.009). Group B also had lower grade of prosthesis regurgitation (0.35 +/- 0.62 v 0.89 +/- 1.1, P =.002). Sizing of pericardial stentless aortic valves by annulus diameter plus 3 to 4 mm provides better valve competence and hemodynamic efficiency by improving aortic root geometry and distensibility. Pericardial stentless valves may be of advantage in elderly patients with significant geometric root mismatch.
本研究的目的是确定心包无支架瓣膜的尺寸策略对血流动力学性能和主动脉根部几何形状的影响。对110例连续植入患者中的103例进行了出院时超声心动图检查（54例男性和49例女性，平均年龄75±9岁，36%合并冠状动脉搭桥术）。在前50例植入患者中（A组，n = 48），瓣膜假体尺寸基于最大瓣环尺寸加1至2毫米。经过连续超声评估后，在接下来的60例植入患者中（B组，n = 55），尺寸策略改为瓣环尺寸加3至4毫米。通过主动脉根部的手术重塑，使窦管（ST）交界处保持在瓣环尺寸的115%以内。与A组相比，B组在相同体表面积和左心室腔大小的患者中植入的瓣膜尺寸大7%（25.2±2.1毫米对23.6±2.3毫米，P <.01）。然而，B组的平均压力阶差低38%（4.0±2.7对6.5±3.2毫米汞柱，P <.01），有效瓣口面积大32%（2.3±0.9平方厘米对1.7±0.7平方厘米，P <.01），根部可扩张性更好（9.3%±6.0%对6.8%±4.1%，P =.026），ST交界处与瓣膜尺寸的比值更低（0.92±0.13对0.99±0.14，P =.009）。B组的假体反流程度也更低（0.35±0.62对0.89±1.1，P =.002）。通过瓣环直径加3至4毫米来确定心包无支架主动脉瓣膜的尺寸，可通过改善主动脉根部几何形状和可扩张性来提供更好的瓣膜功能和血流动力学效率。心包无支架瓣膜可能对存在明显根部几何形状不匹配的老年患者有益。
