Department of Cardiovascular Surgery, University Heart Center, University Hospital Eppendorf, Hamburg, Germany.
Ann Thorac Surg. 2009 Dec;88(6):2061-8. doi: 10.1016/j.athoracsur.2009.06.060.
This review article analyzes the literature to answer the question of whether stentless aortic bioprostheses possess proven advantages compared with stented bioprosthesis, and which patients might benefit from stentless valve implantation. For this purpose, the United States National Library of Medicine's PubMed and MEDLINE databases were searched for articles dealing with results of stentless aortic bioprostheses or studies comparing stented and stentless prostheses. Key word searches used were as follows: stentless aortic prostheses, stented aortic prosthesis, hemodynamic, hemodynamic performance, degeneration, durability, technique, and long-term follow-up. The analysis focused on stentless prostheses with a clinical experience for more than 5 years. Only a few randomized studies were found. Stentless prostheses were found to be advantageous in patients with severe impaired left ventricular function or a small aortic annulus (ie, evidence of grade II), but no specific advantages could be determined for the majority of patients. The durability results were mixed: the Toronto SPV (St. Jude Medical, Minneapolis, MN) showed an increase in degeneration after 10 years of follow-up, whereas the Freestyle porcine stentless prostheses (Medtronic, Minneapolis, MN) still showed excellent results after this period.
这篇综述分析了文献，旨在回答以下问题：与带支架的生物瓣相比，无支架主动脉生物瓣是否具有明确优势？哪些患者可能从无支架瓣膜植入中获益？为此，检索了美国国立医学图书馆的 PubMed 和 MEDLINE 数据库，以获取涉及无支架主动脉生物瓣结果的文章或比较带支架和无支架假体的研究。使用的关键词搜索如下：无支架主动脉假体、带支架主动脉假体、血流动力学、血流动力学性能、退行性变、耐久性、技术和长期随访。分析重点是临床经验超过 5 年的无支架假体。仅发现了少数随机研究。对于左心室功能严重受损或主动脉瓣环较小（即 II 级）的患者，无支架假体具有优势，但对于大多数患者，尚无特定优势。耐久性结果不一：Toronto SPV（St. Jude Medical，明尼苏达州明尼阿波利斯）在随访 10 年后显示退行性变增加，而在此期间，Medtronic 的 Freestyle 猪无支架假体仍显示出出色的结果。
