Gegouskov V A, Eckstein F S, Kipfer B, Berdat P A, Immer F F, Schmidli J, Seiler C, Zobrist C, Carrel T P
Klinik für Herz- und Gefässchirurgie, Universitätsspital Inselspital, Bern, Schweiz.
Swiss Surg. 2003;9(5):247-52. doi: 10.1024/1023-9332.9.5.247.
The Sorin Pericarbon Freedom Stentless aortic valve has the potential to provide superior hemodynamic function and durability. In this study we assessed the hemodynamic performance of this valve and its impact on LV-mass regression after aortic valve replacement.
31 consecutive patients who received a Sorin Pericarbon Freedom Stentless aortic valve were analysed. Mean age of the patients (16 female and 15 male) was 64 +/- 17 years. Five patients had isolated aortic stenosis, three isolated aortic regurgitation and one combined aortic valve disease. Three patients had combined aortic and mitral valve disease, 14 patients concomitant coronary artery disease, one congenital aortic coarctation. Three patients had an acute aortic valve endocarditis. 18 patients were classified as high-risk patients (mean EuroSCORE 9 +/- 2). Mean left ventricular ejection fraction was 52.5 +/- 15.0%.
Valve sizes from 21 mm to 29 mm were implanted. The valves were oversized by 2 mm compared to measurement. 16 patients received isolated aortic valve replacement, Three patients aortic valve replacement and mitral valve reconstruction. 12 patients had concomitant CABG. Three procedures were reoperations. Hospital mortality was 6.4% (two patients). Both deaths occurred in high-risk patients and were not valve-related. Four patients had perioperative low-output-syndrome and needed IABP. After six months a follow up echocardiography was performed. Mean and peak gradients were 9.6 +/- 4.4 and 20.6 +/- 5.9 mmHg, respectively. Significant reduction of left ventricular hypertrophy (LV mass index 126.5 +/- 27.3 vs. 189.6 +/- 45.3 g/m2, p = 0.0313) and improvement of the ejection fraction (58 +/- 9.8 vs. 52.5 +/- 15.0%, p = 0.9749) as compared with preoperative valve.
The hemodynamic performance of the Sorin Pericarbon Freedom Stentless aortic valve is excellent and the patient outcome is satisfying. However the implantation technique requires longer ischemic time, the prosthesis offers very satisfying hemodynamic function and accelerates probably the LV-mass regression in the mid term follow-up. Late performance and durability of the valve have to be assessed.
索林Pericarbon Freedom无支架主动脉瓣有潜力提供卓越的血流动力学功能和耐用性。在本研究中，我们评估了该瓣膜的血流动力学性能及其对主动脉瓣置换术后左心室质量消退的影响。
对连续31例接受索林Pericarbon Freedom无支架主动脉瓣置换的患者进行分析。患者平均年龄（16例女性和15例男性）为64±17岁。5例患者为单纯主动脉瓣狭窄，3例为单纯主动脉瓣关闭不全，1例为主动脉瓣联合病变。3例患者有主动脉瓣和二尖瓣联合病变，14例患者合并冠状动脉疾病，1例先天性主动脉缩窄。3例患者有急性主动脉瓣心内膜炎。18例患者被归类为高危患者（平均欧洲心脏手术风险评估系统评分为9±2）。平均左心室射血分数为52.5±15.0%。
植入的瓣膜尺寸为21毫米至29毫米。与测量值相比，瓣膜尺寸大2毫米。16例患者接受单纯主动脉瓣置换，3例患者接受主动脉瓣置换和二尖瓣重建。12例患者同时进行冠状动脉旁路移植术。3例手术为再次手术。医院死亡率为6.4%（2例患者）。两例死亡均发生在高危患者中，与瓣膜无关。4例患者出现围手术期低心排血量综合征，需要主动脉内球囊反搏。术后6个月进行超声心动图随访。平均压差和峰值压差分别为9.6±4.4和20.6±5.9毫米汞柱。与术前瓣膜相比，左心室肥厚显著减轻（左心室质量指数126.5±27.3对189.6±45.3克/平方米，p = 0.0313），射血分数有所改善（58±9.8对52.5±15.0%，p = 0.9749）。
索林Pericarbon Freedom无支架主动脉瓣的血流动力学性能优异，患者预后令人满意。然而，植入技术需要更长的缺血时间，该人工瓣膜提供了非常令人满意的血流动力学功能，并可能在中期随访中加速左心室质量消退。瓣膜的远期性能和耐用性有待评估。
