Folliguet Thierry, Dibie Alain, Laborde François
Department of Cardiovascular Surgery, L'institut Mutualiste Montsouris, 42 Boulevard Jourdan, Paris 75014, France.
Future Cardiol. 2009 Sep;5(5):443-52. doi: 10.2217/fca.09.35.
Aortic valve replacement with mechanical or biological heart valves is the treatment of choice for aortic valve stenosis when it is symptomatic or with severe aortic stenosis (< or = 0.6 cm(2)/m(2)) or with left ventricular dysfunction. In an effort to improve the outcomes of patients with stented biological valves, stentless valves were introduced to clinical practices in the early 1990s. Theses valves were designed to be less obstructive, and thus result in a lower transvalvular gradient. Technically the implantations of these valves are more demanding resulting in longer cross clamp and bypass times. However, important comorbid conditions in elderly patients referred for aortic valve replacement require alternative treatment options with possible reductions of the extracorporeal bypass time and reliable hemodynamic features. In order to comply with these requirements, percutaneous valves and sutureless surgical valves have been developed. The percutaneous technique has the advantage of being performed without circulatory bypass but leaving the aortic calcifications in place, thereby resulting in a high degree of paravalvular insufficiency, atrioventricular block and strokes. The surgical approach has the advantage of removing all calcifications and the valves can be optimally implanted, resulting in minimal paravalvular leak with a low incidence of atrioventricular block and strokes; however, it requires cardiopulmonary bypass. In addition, it can be performed with a low mortality (<3% in isolated aortic replacement, even in older patients). This article reviews the various techniques, strength and limitations of these sutureless valves implanted in the aortic position.
对于有症状的主动脉瓣狭窄、重度主动脉瓣狭窄（<或=0.6平方厘米/平方米）或左心室功能不全的患者，采用机械或生物心脏瓣膜进行主动脉瓣置换是首选治疗方法。为了改善置入支架生物瓣膜患者的治疗效果，无支架瓣膜于20世纪90年代初引入临床实践。这些瓣膜的设计旨在减少梗阻，从而降低跨瓣压差。从技术上讲，这些瓣膜的植入要求更高，导致主动脉阻断和体外循环时间更长。然而，因主动脉瓣置换而转诊的老年患者的重要合并症需要有替代治疗方案，可能要减少体外循环时间并具备可靠的血流动力学特征。为了满足这些要求，已经开发出经皮瓣膜和无缝合手术瓣膜。经皮技术的优点是无需体外循环即可进行，但主动脉钙化仍留在原位，从而导致高度的瓣周漏、房室传导阻滞和中风。手术方法的优点是可以清除所有钙化，瓣膜可以最佳方式植入，瓣周漏最小，房室传导阻滞和中风的发生率低；然而，它需要体外循环。此外，该手术死亡率较低（单纯主动脉置换时<3%，即使是老年患者）。本文综述了这些置于主动脉位置的无缝合瓣膜的各种技术、优点和局限性。
