Doss Mirko, Wood Jeffrey P, Kiessling Arndt H, Moritz Anton
Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt am Main, Germany.
J Cardiothorac Surg. 2011 Oct 13;6:136. doi: 10.1186/1749-8090-6-136.
We assessed the hemodynamic performance of various prostheses and the clinical outcomes after aortic valve replacement, in different age groups.
One-hundred-and-twenty patients with isolated aortic valve stenosis were included in this prospective randomized randomised trial and allocated in three age-groups to receive either pulmonary autograft (PA, n = 20) or mechanical prosthesis (MP, Edwards Mira n = 20) in group 1 (age < 55 years), either stentless bioprosthesis (CE Prima Plus n = 20) or MP (Edwards Mira n = 20) in group 2 (age 55-75 years) and either stentless (CE Prima Plus n = 20) or stented bioprosthesis (CE Perimount n = 20) in group 3 (age > 75). Clinical outcomes and hemodynamic performance were evaluated at discharge, six months and one year.
In group 1, patients with PA had significantly lower mean gradients than the MP (2.6 vs. 10.9 mmHg, p = 0.0005) with comparable left ventricular mass regression (LVMR). Morbidity included 1 stroke in the PA population and 1 gastrointestinal bleeding in the MP subgroup. In group 2, mean gradients did not differ significantly between both populations (7.0 vs. 8.9 mmHg, p = 0.81). The rate of LVMR and EF were comparable at 12 months; each group with one mortality. Morbidity included 1 stroke and 1 gastrointestinal bleeding in the stentless and 3 bleeding complications in the MP group. In group 3, mean gradients did not differ significantly (7.8 vs 6.5 mmHg, p = 0.06). Postoperative EF and LVMR were comparable. There were 3 deaths in the stented group and no mortality in the stentless group. Morbidity included 1 endocarditis and 1 stroke in the stentless compared to 1 endocarditis, 1 stroke and one pulmonary embolism in the stented group.
Clinical outcomes justify valve replacement with either valve substitute in the respective age groups. The PA hemodynamically outperformed the MPs. Stentless valves however, did not demonstrate significantly superior hemodynamics or outcomes in comparison to stented bioprosthesis or MPs.
我们评估了不同年龄组患者在主动脉瓣置换术后各种人工瓣膜的血流动力学性能及临床结局。
本前瞻性随机试验纳入了120例单纯主动脉瓣狭窄患者，并将其分为三个年龄组。在第1组（年龄<55岁）中，20例患者接受肺动脉自体移植瓣膜（PA），20例患者接受机械瓣膜（MP，爱德华兹美拉瓣膜）；在第2组（年龄55 - 75岁）中，20例患者接受无支架生物瓣膜（CE Prima Plus），20例患者接受MP（爱德华兹美拉瓣膜）；在第3组（年龄>75岁）中，20例患者接受无支架生物瓣膜（CE Prima Plus），20例患者接受有支架生物瓣膜（CE Perimount）。在出院时、术后6个月和1年评估临床结局和血流动力学性能。
在第1组中，接受PA的患者平均跨瓣压差显著低于接受MP的患者（2.6 vs. 10.9 mmHg，p = 0.0005），左心室质量回归（LVMR）相当。并发症方面，PA组有1例中风，MP亚组有1例胃肠道出血。在第2组中，两组患者的平均跨瓣压差无显著差异（7.0 vs. 8.9 mmHg，p = 0.81）。12个月时LVMR和射血分数（EF）相当；每组各有1例死亡。并发症方面，无支架组有1例中风和1例胃肠道出血，MP组有3例出血并发症。在第3组中，平均跨瓣压差无显著差异（7.8 vs 6.5 mmHg，p = 0.06）。术后EF和LVMR相当。有支架组有3例死亡，无支架组无死亡。并发症方面，无支架组有1例心内膜炎和1例中风，有支架组有1例心内膜炎、1例中风和1例肺栓塞。
临床结局表明在各自年龄组中使用任何一种瓣膜替代品进行瓣膜置换都是合理的。PA在血流动力学方面优于MP。然而，与有支架生物瓣膜或MP相比，无支架瓣膜在血流动力学或结局方面并未显示出显著优势。
