Perez de Arenaza Diego, Lees Belinda, Flather Marcus, Nugara Fiona, Husebye Trygve, Jasinski Marek, Cisowski Marek, Khan Mohammed, Henein Michael, Gaer Jullien, Guvendik Levant, Bochenek Andrzej, Wos Stanislaw, Lie Mons, Van Nooten Guido, Pennell Dudley, Pepper John
Royal Brompton and Harefield NHS Trust, London, UK.
Circulation. 2005 Oct 25;112(17):2696-702. doi: 10.1161/CIRCULATIONAHA.104.521161. Epub 2005 Oct 17.
Aortic valve replacement (AVR) is the established treatment for severe aortic stenosis. In response to the long-term results of aortic homografts, stentless porcine valves were introduced as an alternative low-resistance valve. We conducted a randomized trial comparing a stentless with a stented porcine valve in adults with severe aortic stenosis.
The primary outcome was change in left ventricular mass index (LVMI) measured by transthoracic echocardiography and, in a subset, by cardiovascular MR. Measurements were taken before valve replacement and at 6 and 12 months. Patients undergoing AVR with an aortic annulus < or =25 mm in diameter were randomly allocated to a stentless (n=93) or a stented supra-annular (n=97) valve. There were no significant differences in mean LVMI between the stentless versus stented groups at baseline (176+/-62 and 182+/-63 g/m2, respectively) or at 6 months (142+/-49 and 131+/-45 g/m2, respectively), although within-group changes from baseline to 6 months were highly significant. Changes in LVMI measured by cardiovascular MR (n=38) were consistent with the echo findings. There was a greater reduction in peak aortic velocity (P<0.001) and a greater increase in indexed effective orifice area (P<0.001) in the stentless group than in the stented group. There were no differences in clinical outcomes between the 2 valve groups.
Despite significant differences in indexed effective orifice area and peak flow velocity in favor of the stentless valve, there were similar reductions in left ventricular mass at 6 months with both stented and stentless valves, which persisted at 12 months.
主动脉瓣置换术（AVR）是重度主动脉瓣狭窄的既定治疗方法。鉴于主动脉同种异体移植物的长期效果，无支架猪瓣膜作为一种低阻力瓣膜替代物被引入。我们进行了一项随机试验，比较无支架猪瓣膜和有支架猪瓣膜在重度主动脉瓣狭窄成人患者中的应用。
主要结局是经胸超声心动图测量的左心室质量指数（LVMI）变化，部分患者通过心血管磁共振成像测量。在瓣膜置换术前、术后6个月和12个月进行测量。主动脉瓣环直径≤25mm的接受AVR的患者被随机分配至无支架瓣膜组（n = 93）或有支架瓣环上瓣膜组（n = 97）。无支架组与有支架组在基线时（分别为176±62和182±63g/m²）或6个月时（分别为142±49和131±45g/m²）的平均LVMI无显著差异，尽管两组内从基线到6个月的变化非常显著。通过心血管磁共振成像测量的LVMI变化（n = 38）与超声心动图结果一致。无支架组的主动脉峰值流速降低幅度更大（P<0.001），指数化有效瓣口面积增加幅度更大（P<0.00）。两组瓣膜的临床结局无差异。
尽管指数化有效瓣口面积和峰值流速存在显著差异，表明无支架瓣膜更具优势，但有支架瓣膜和无支架瓣膜在6个月时左心室质量的降低幅度相似，且在12个月时仍持续存在。
