无支架主动脉瓣在中期随访期间血流动力学上优于有支架瓣膜：一项大型回顾性研究。

Stentless aortic valves are hemodynamically superior to stented valves during mid-term follow-up: a large retrospective study.

作者信息

Borger Michael A, Carson Susan M, Ivanov Joan, Rao Vivek, Scully Hugh E, Feindel Christopher M, David Tirone E

机构信息

Division of Cardiovascular Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.

出版信息

Ann Thorac Surg. 2005 Dec;80(6):2180-5. doi: 10.1016/j.athoracsur.2005.05.055.

DOI:10.1016/j.athoracsur.2005.05.055

PMID:16305867

Abstract

BACKGROUND

Several studies have compared left venticular mass (LVM) regression and hemodynamic data for stentless versus stented aortic bioprostheses with conflicting results. The major limitations of these studies are their small sample size and short-term follow-up. We therefore compared midterm LVM regression, hemodynamic data, and survival in a large population of tissue aortic valve replacement (AVR) patients.

METHODS

All patients undergoing tissue AVR at our institution between 1998 and 2001 were included (n = 737). Patients were divided into two groups according to type of bioprosthetic implanted: stentless patients (total n = 310) (Toronto SPV [St Jude Medical, St Paul, MN], n = 146 and Freestyle [Medtronic, Minneapolis, MN], n = 164) and stented patients (total n = 427) (Perimount [Edwards Life Sciences Inc, Irvine, CA], n = 291 and Mosaic [Medtronic], n = 136).

RESULTS

The two groups of patients had similar preoperative transvalvular gradients and LVM index (130 +/- 47 vs 130 +/- 42 g/m2 for stentless versus stented valves, respectively). Predischarge echos revealed that stentless patients had significantly lower mean transvalvular gradients (11 +/- 5 vs 15 +/- 6 mm Hg, p < 0.001) and larger effective orifice areas (1.32 +/- 0.52 vs 1.22 +/- 0.48 cm2, p = 0.01). Follow-up echocardiograms were obtained in 99% of surviving patients 28 +/- 22 (range, 0-79) months postoperatively. Stentless patients had significantly lower LVM index during follow-up (100 +/- 32 vs 107 +/- 32 g/m2, p = 0.005) and stentless valves were an independent predictor of LVM regression. Furthermore, a higher proportion of stented patients had residual LV hypertrophy during follow-up (28% vs 18%, p = 0.001). Stentless valves were associated with improved midterm survival by univariate analysis, but not by multivariable analysis.

CONCLUSIONS

Midterm follow-up in a large number of patients reveals that stentless bioprostheses are hemodynamically superior to stented valves.

摘要

背景

多项研究比较了无支架与有支架主动脉生物瓣膜的左心室质量（LVM）回归情况及血流动力学数据，结果相互矛盾。这些研究的主要局限性在于样本量小和随访时间短。因此，我们比较了大量组织主动脉瓣置换（AVR）患者的中期LVM回归情况、血流动力学数据及生存率。

方法

纳入1998年至2001年间在我们机构接受组织AVR的所有患者（n = 737）。根据植入的生物瓣膜类型将患者分为两组：无支架患者（共n = 310）（多伦多SPV[圣犹达医疗公司，明尼苏达州圣保罗]，n = 146；自由式[美敦力公司，明尼阿波利斯，明尼苏达州]，n = 164）和有支架患者（共n = 427）（百慕大[爱德华生命科学公司，加利福尼亚州欧文]，n = 291；马赛克[美敦力]，n = 136）。

结果

两组患者术前跨瓣压差和LVM指数相似（无支架瓣膜与有支架瓣膜分别为130±47 vs 130±42 g/m²）。出院前超声心动图显示，无支架患者的平均跨瓣压差显著更低（11±5 vs 15±6 mmHg，p < 0.001），有效瓣口面积更大（1.32±0.52 vs 1.22±0.48 cm²，p = 0.01）。99%的存活患者在术后28±22（范围0 - 79）个月进行了随访超声心动图检查。随访期间，无支架患者的LVM指数显著更低（100±32 vs 107±32 g/m²，p = 0.005），无支架瓣膜是LVM回归的独立预测因素。此外，随访期间有支架患者左心室肥厚残留的比例更高（28% vs 18%，p = 0.001）。单因素分析显示无支架瓣膜与中期生存率提高相关，但多因素分析未显示。