Dellgren Göran, Feindel Christopher M, Bos Joanne, Ivanov Joan, David Tirone E
Division of Cardiovascular Surgery, The Toronto General Hospital, 200 Elizabeth Street, EN 14-222, Toronto, Ontario, Canada M5N 2C4.
Eur J Cardiothorac Surg. 2002 Apr;21(4):698-702. doi: 10.1016/s1010-7940(02)00029-5.
Long-term durability and hemodynamics of stentless valves are unknown. Therefore, this study was undertaken to evaluate long-term clinical and echocardiographic outcome after aortic valve replacement with the Toronto stentless porcine valve (SPV) bioprosthesis at our institution.
Between 1991 and 1998, the Toronto SPV was implanted in 255 patients (mean age, 63+/-11 years, range 22-83 years, 181 males and 74 females). Preoperative diagnoses were aortic stenosis (76%), aortic insufficiency (12%) and mixed lesion (12%). New York Heart Association class III and IV were present in 49% (126/255) of the patients preoperatively. Mean valve size implanted was 26.5+/-2.1mm and in addition 34% (86/255) of the patients had coronary artery bypass surgery.
Early mortality was 0.8% (2/255). Actuarial survival at 7 years was 90+/-3%. At 7 years, the freedom from cardiac death was 98+/-2%; from valve-related death, 99+/-1%; from valve reoperation, 97+/-2%; from structural valve degeneration, 97+/-2%; from thromboembolism, 95+/-2%; and from endocarditis, 99+/-1%. At 7 years of follow-up, the transvalvular peak and mean pressure differences across the aortic valve measured with Doppler echocardiography was 9.6+/-5.1 and 3.6+/-2.0 mmHg, respectively.
The Toronto SPV has provided excellent clinical and hemodynamic results up until 7 years of follow-up.
无支架瓣膜的长期耐用性和血流动力学尚不清楚。因此，本研究旨在评估在我们机构使用多伦多无支架猪瓣膜（SPV）生物假体进行主动脉瓣置换术后的长期临床和超声心动图结果。
1991年至1998年间，255例患者（平均年龄63±11岁，范围22 - 83岁，男性181例，女性74例）植入了多伦多SPV。术前诊断为主动脉瓣狭窄（76%）、主动脉瓣关闭不全（12%）和混合病变（12%）。术前49%（126/255）的患者为纽约心脏协会III级和IV级。植入瓣膜的平均尺寸为26.5±2.1mm，此外34%（86/255）的患者进行了冠状动脉搭桥手术。
早期死亡率为0.8%（2/255）。7年时的精算生存率为90±3%。7年时，无心脏死亡的概率为98±2%；无瓣膜相关死亡的概率为99±1%；无瓣膜再次手术的概率为97±2%；无结构性瓣膜退变的概率为97±2%；无血栓栓塞的概率为95±2%；无感染性心内膜炎的概率为99±1%。在7年的随访中，用多普勒超声心动图测量的主动脉瓣跨瓣峰值和平均压差分别为9.6±5.
