用于主动脉瓣置换的猪源或人源无支架瓣膜？一项10年比较研究的结果。

Porcine or human stentless valves for aortic valve replacement? Results of a 10-year comparative study.

作者信息

Ali Ayyaz, Lim Eric, Halstead James, Ashrafian Hutan, Ali Ziad, Khalpey Zain, Theodorou Panagiotis, Chamageorgakis Themis, Kumar Pankaj, Jackson Christopher, Pepper John

机构信息

Department of Cardiothoracic Surgery, Royal Brompton Hospital, London, UK.

出版信息

J Heart Valve Dis. 2003 Jul;12(4):430-5; discussion 435.

PMID:12918841

Abstract

BACKGROUND AND AIM OF THE STUDY

Stentless porcine valves in the aortic position exhibit similar excellent hemodynamic performance to homografts, but have the advantage of availability. Their performance was compared over a 10-year period in a single-surgeon and single-institution series.

METHODS

Demographic, operative and mortality data were obtained retrospectively. Survivors were interviewed by telephone according to a defined protocol. Definitions and analyses were in accordance with joint STS/AATS guidelines.

RESULTS

A total of 408 stentless porcine and homograft aortic valve replacements (AVR) was performed between 1991 and 2001. Five patients were excluded due to incomplete data, in addition to 82 patients who underwent AVR with a free-standing root replacement technique. Hence, 321 patients (217 males, 104 females; mean age 67 +/- 12 years) had a subcoronary implant. The median time to follow up was 4.9 years (range: 2.9-6.6 years). No differences were noted between homograft and stentless porcine valves in one- and five-year freedom from structural valve deterioration (99.1 versus 97.2% and 95.7 versus 93.1%; p = 0.10), reoperation (99.2 versus 99.4% and 97.8 versus 96.7%; p = 0.45) and endocarditis (98.3 versus 99.4% and 97.4 versus 99.4%; p = 0.14). Overall one- and five-year survival comparing homograft to stentless porcine valve was 90.4 versus 92.3% and 80.8 versus 73.7%, respectively; p = 0.23. Independent predictors of mortality on multivariate analysis were: ventricular function (p < 0.0001), increasing age (p < 0.001), increasing serum creatinine (p < 0.001) and concomitant coronary surgery (p = 0.05). Treated hypercholesterolemia was independently protective against mortality, with an odds ratio of 0.26 (CI 0.10 to 0.66; p = 0.005).

CONCLUSION

The porcine stentless valve, when implanted in the subcoronary position, is an excellent alternative to the homograft and shows excellent clinical performance and durability at mid term.

摘要

研究背景与目的

主动脉位置的无支架猪瓣膜展现出与同种异体移植物相似的优异血流动力学性能，但具有可得性优势。在一项单外科医生和单机构系列研究中，对其10年期间的性能进行了比较。

方法

回顾性获取人口统计学、手术及死亡率数据。根据既定方案通过电话对幸存者进行访谈。定义和分析符合STS/AATS联合指南。

结果

1991年至2001年期间共进行了408例无支架猪瓣膜和同种异体主动脉瓣膜置换术（AVR）。除82例采用独立根部置换技术进行AVR的患者外，5例因数据不完整被排除。因此，321例患者（217例男性，104例女性；平均年龄67±12岁）接受了冠状动脉下植入。随访时间中位数为4.9年（范围：2.9 - 6.6年）。在瓣膜结构恶化的1年和5年免于率方面（99.1%对97.2%以及95.7%对93.1%；p = 0.10）、再次手术率方面（99.2%对99.4%以及97.8%对96.7%；p = 0.45）和心内膜炎发生率方面（98.3%对99.4%以及97.4%对99.4%；p = 0.14），同种异体移植物和无支架猪瓣膜之间未发现差异。同种异体移植物与无支架猪瓣膜相比，总体1年和5年生存率分别为90.4%对92.3%以及80.8%对73.7%；p = 0.23。多因素分析中死亡率的独立预测因素为：心室功能（p < 0.0001）、年龄增加（p < 0.001）、血清肌酐升高（p < 0.001）以及同期冠状动脉手术（p = 0.05）。接受治疗的高胆固醇血症对死亡率具有独立保护作用，比值比为0.26（CI 0.10至0.66；p = 0.005）。