Martinovic Ivo, Everlien Manfred, Farah Ibrahim, Wittlinger Thomas, Knez Igor, Greve Hans, Vogt Paul
Department of Cardiothoracic Surgery, Klinikum Krefeld, Krefeld, Germany.
Ann Thorac Surg. 2005 Jul;80(1):198-203. doi: 10.1016/j.athoracsur.2005.01.027.
It is suggested that a simplified implant model Cryolife-O'Brien (CryoLife International, Kennesaw, GA) offers less satisfactory outcome compared with standard stentless models. This study was conducted to prospectively evaluate the midterm results after aortic valve replacement with the Cryolife-O'Brien stentless bioprosthesis.
In 1996, a prospective clinical trial using different stentless valves was initiated. From September 1996 through September 2002, 156 consecutive patients with a mean age of 74.5 years underwent aortic valve replacement with the Cryolife-O'Brien porcine stentless bioprosthesis. The predominant aortic valve lesion was stenosis in 128 and insufficiency in 28 cases. Patients have been followed from 2 to 72 months (mean, 42 months). Echocardiography was performed by one echocardiographer preoperatively, intraoperatively, postoperatively at discharge, 2 to 6 months later, and annually thereafter.
Sixty percent of patients received a valve 25 mm in diameter or larger; 39% had concomittant coronary bypass grafting. The 30-day operative mortality rate was 6.4%. Ten late nonvalve-related deaths have occurred. Severe aortic insufficiency caused by oversizing leads to early reoperation in 3 patients. The peak and mean systolic gradients decreased significantly during the first 12 months after implantation, p < 0.001, and the effective valve areas increased significantly during this time interval p < 0.001. At 5 years, ten patients have moderate aortic insufficiency. The actuarial survival at 5 years was 88 +/- 3%. The rate for freedom from endocarditis was 100% and for freedom from thromboembolic events was 94%.
Midterm results after aortic valve replacement with the Cryolife-O'Brien stentless bioprosthesis are encouraging. Good hemodynamics have been coupled with low rate of valve-related complications, thus representing a very good alternative to conventional stented bioprostheses.
有人认为，与标准无支架模型相比，简化的植入模型Cryolife-O'Brien（Cryolife International，美国佐治亚州肯尼索）的效果欠佳。本研究旨在前瞻性评估使用Cryolife-O'Brien无支架生物瓣膜进行主动脉瓣置换术后的中期结果。
1996年启动了一项使用不同无支架瓣膜的前瞻性临床试验。从1996年9月至2002年9月，156例平均年龄74.5岁的连续患者接受了Cryolife-O'Brien猪无支架生物瓣膜主动脉瓣置换术。主要的主动脉瓣病变为狭窄128例，关闭不全28例。对患者进行了2至72个月（平均42个月）的随访。术前、术中、术后出院时、术后2至6个月以及此后每年由一名超声心动图医生进行超声心动图检查。
60%的患者接受了直径25毫米或更大的瓣膜；39%的患者同时进行了冠状动脉搭桥术。30天手术死亡率为6.4%。发生了10例晚期非瓣膜相关死亡。瓣膜尺寸过大导致的严重主动脉瓣关闭不全致使3例患者早期再次手术。植入后的前12个月内，峰值和平均收缩期梯度显著降低（p<0.001），在此时间间隔内有效瓣口面积显著增加（p<0.001）。5年时，10例患者有中度主动脉瓣关闭不全。5年时的精算生存率为88±3%。无感染性心内膜炎的发生率为100%，无血栓栓塞事件的发生率为94%。
使用Cryolife-O'Brien无支架生物瓣膜进行主动脉瓣置换术后的中期结果令人鼓舞。良好的血流动力学与较低的瓣膜相关并发症发生率相结合，因此是传统有支架生物瓣膜的一个非常好的替代选择。
