De Carlo Marco, Milano Aldo D, Nardi Carmela, Mecozzi Gianclaudio, Bortolotti Uberto
Cardiothoracic Department, University of Pisa Medical School, 56124 Pisa, Italy.
J Thorac Cardiovasc Surg. 2003 Aug;126(2):337-43. doi: 10.1016/s0022-5223(02)73395-3.
The Sorin Bicarbon prosthesis (Sorin Biomedica, Saluggia, Italy) is a bileaflet valve with curved-profile leaflets, a rolling hinge mechanism, and a pyrolytic carbon-coated titanium alloy housing and sewing ring. Although the Sorin Bicarbon prosthesis has been implanted in greater than 80,000 patients, and reference values on the hemodynamic performance of valve prostheses are needed to avoid patient-prosthesis mismatch, few Doppler echocardiographic data are available on the prosthesis in the aortic position. The aim of this study is to provide a detailed echocardiographic evaluation of the hemodynamic performance and regression of left ventricular hypertrophy after aortic valve replacement with the Sorin Bicarbon prosthesis.
The study included 182 patients who received a 21-mm (n = 61) or 23-mm (n = 121) Sorin Bicarbon prosthesis for pure or prevalent aortic stenosis who underwent serial echocardiograms at 3, 6, and 12 months after aortic valve replacement.
Mean and peak gradients significantly decreased (P <.001) during follow-up to values of 12 +/- 3 and 22 +/- 6 mm Hg for the 21-mm prosthesis and values of 11 +/- 4 and 19 +/- 6 mm Hg for the 23-mm prosthesis at 1 year. Left ventricular mass index showed a 17% decrease to 120 +/- 27 g/m(2) in recipients of the 21-mm prosthesis (P <.001) and a 21% decrease to 123 +/- 29 g/m(2) in recipients of the 23-mm prosthesis (P <.001). A larger prosthesis size was the only predictor of a higher left ventricular mass index regression. Among recipients of the 21-mm prosthesis, body surface area of greater than 1.85 m(2) was associated with a lower regression of left ventricular mass index. The effective orifice area index was 1.00 +/- 0.11 and 1.08 +/- 0.14 cm(2)/m(2) in recipients of the 21-mm and 23-mm prostheses, respectively.
Size 21 mm and 23 mm Sorin Bicarbon prostheses show low transprosthetic gradients, with significant reduction of left ventricular mass index during the first postoperative year. The reported effective orifice areas might be useful for aortic valve replacement in patients with a small aortic annulus to avoid patient-prosthesis mismatch.
索林双叶瓣人工心脏瓣膜（索林生物医学公司，意大利萨卢贾）是一种双叶瓣瓣膜，其瓣叶呈曲线形，具有滚动铰链机制，外壳及缝合环由热解碳涂层钛合金制成。尽管索林双叶瓣人工心脏瓣膜已植入超过80000例患者体内，且为避免患者与人工瓣膜不匹配需要人工心脏瓣膜血流动力学性能的参考值，但关于主动脉位置人工瓣膜的多普勒超声心动图数据却很少。本研究的目的是对使用索林双叶瓣人工心脏瓣膜进行主动脉瓣置换术后的血流动力学性能及左心室肥厚消退情况进行详细的超声心动图评估。
本研究纳入了182例因单纯性或重度主动脉瓣狭窄接受21毫米（n = 61）或23毫米（n = 121）索林双叶瓣人工心脏瓣膜置换术的患者，这些患者在主动脉瓣置换术后3、6和12个月接受了系列超声心动图检查。
随访期间，平均梯度和峰值梯度显著降低（P <.001），1年后，21毫米人工瓣膜的平均梯度和峰值梯度分别降至12±3毫米汞柱和22±6毫米汞柱，23毫米人工瓣膜的平均梯度和峰值梯度分别降至11±4毫米汞柱和19±6毫米汞柱。21毫米人工瓣膜植入者的左心室质量指数下降了17%，降至120±27克/平方米（P <.001）；23毫米人工瓣膜植入者的左心室质量指数下降了21%，降至123±29克/平方米（P <.001）。更大的人工瓣膜尺寸是左心室质量指数消退更高的唯一预测因素。在21毫米人工瓣膜植入者中，体表面积大于1.85平方米与左心室质量指数消退较低有关。21毫米和23毫米人工瓣膜植入者的有效瓣口面积指数分别为1.00±0.11平方厘米/平方米和1.08±0.14平方厘米/平方米。
21毫米和23毫米的索林双叶瓣人工心脏瓣膜跨瓣压差较低，术后第一年左心室质量指数显著降低。所报道的有效瓣口面积可能有助于主动脉瓣环较小的患者进行主动脉瓣置换，以避免患者与人工瓣膜不匹配。
