Deleuze Philippe H, Fromes Yves, Khoury Wassim, Maribas Philippe, Lemaire Sacha, Bical Olivier M
St. Joseph Hospital, Paris, France.
J Heart Valve Dis. 2006 Mar;15(2):247-52.
Stentless bioprostheses may be the future valve of choice for aortic valve replacement (AVR). The study aim was to investigate mid-term clinical outcome after AVR with the Medtronic Freestyle valve.
Between April 1997 and November 2004, a total of 500 patients (241 females, 259 males) was implanted with a Freestyle bioprosthesis for AVR, without population selection, by a single surgical team at the authors' institutions. Mean patient age was 74.5 +/- 9.6 years (range: 26-91 years); 34 patients (7%) were aged < 60 years, 121 (24%) were aged > 80 years, and 205 (41%) were in NYHA classes III or IV. The surgical procedure used included a modified subcoronary technique in 482 cases and complete root replacement in 18, conducted with mini-extracorporeal circulation. Concomitant procedures included coronary artery bypass grafting in 123 patients (25%), mitral valve repair/replacement in five, and maze in two. Follow up was 98% complete; the mean follow up was 31.3 months (range: 4-95 months).
The mean cardiopulmonary bypass time was 98 +/- 26 min, and total aortic cross-clamp time 77 +/- 19 min. Operative mortality was 5.2% (n = 26), and no patients aged under 60 years died. At eight years, freedom from structural valve deterioration was 100% (0% in the young population), freedom from endocarditis 97.2%, freedom from reoperation 97%, and overall survival 83%. Most of the late deaths (n = 56) were of non-cardiac origin, and occurred in older patients. After one year, the mean aortic echocardiographic gradient was 11.5 +/- 1.1 mmHg, and was improved compared to that at discharge. No significant aortic insufficiency occurred.
Use of the Freestyle stentless bioprosthesis for AVR resulted in excellent short-term survival in the octogenarian population, and excellent mid-term results in the younger population. In time, experience will indicate whether the Freestyle should be considered as the bioprosthesis of choice for patients of all ages.
无支架生物瓣膜可能是未来主动脉瓣置换术（AVR）的首选瓣膜。本研究旨在调查使用美敦力Freestyle瓣膜进行主动脉瓣置换术后的中期临床结果。
1997年4月至2004年11月期间，作者所在机构的一个手术团队对500例患者（241例女性，259例男性）进行了Freestyle生物瓣膜主动脉瓣置换术，未进行人群选择。患者平均年龄为74.5±9.6岁（范围：26 - 91岁）；34例（7%）年龄小于60岁，121例（24%）年龄大于80岁，205例（41%）为纽约心脏协会（NYHA）心功能III或IV级。所采用的手术方法包括482例改良冠状动脉下技术和18例完整根部置换，均在体外循环辅助下进行。同期手术包括123例患者（25%）行冠状动脉旁路移植术，5例行二尖瓣修复/置换术，2例行迷宫手术。随访完成率为98%；平均随访时间为31.3个月（范围：4 - 95个月）。
平均体外循环时间为98±26分钟，主动脉阻断总时间为77±19分钟。手术死亡率为5.2%（n = 26），年龄小于60岁的患者无死亡。8年时，无结构性瓣膜退变的比例为100%（年轻人群中为0%），无感染性心内膜炎的比例为97.2%，无需再次手术的比例为97%，总体生存率为83%。大多数晚期死亡（n = 56）为非心脏原因，且发生在老年患者中。1年后，主动脉超声心动图平均压差为11.5±1.1 mmHg，与出院时相比有所改善。未发生明显主动脉瓣关闭不全。
使用Freestyle无支架生物瓣膜进行主动脉瓣置换术在老年人群中取得了优异的短期生存率，在年轻人群中取得了优异的中期结果。随着时间推移，经验将表明Freestyle是否应被视为所有年龄段患者的首选生物瓣膜。
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