Song Zhigang, Lehr Eric J, Wang Shaohua
Department of Cardiothoracic Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, China.
J Cardiovasc Dis Res. 2012 Jan;3(1):46-51. doi: 10.4103/0975-3583.91594.
Stentless aortic valve prostheses have excellent hemodynamic profiles, but may be associated with an increased postoperative heart block when compared to conventional prostheses.
To assess the effect of an alternative subcoronary implantation technique on postoperative complete heart block (CHB) and permanent pacemaker implantation (PPI) following aortic valve replacement (AVR) with stentless tissue valves.
A total of 130 consecutive patients undergoing AVR with stentless tissue valves by a single surgeon were studied retrospectively.
A stentless tissue valve was implanted into 80 patients using the conventional modified subcoronary implantation technique, and 50 patients received a stentless tissue valve by an alternative subcoronary technique in which the inflow suture line is raised at the level of right-non coronary commissure. Data were collected at the time of hospital discharge and at 6-12 months postoperatively.
Independent samples t-test was used to compare continuous variables, and categorical variables were compared with the chi-square test.
Use of this new method reduced postoperative CHB (4.0% vs. 16.3%, P = 0.033), with fewer patients requiring PPI in the early postoperative period (6.0% vs. 18.8%, P = 0.041). Echocardiographic examination showed no differences in the effective orifice area, peak and mean aortic valve gradients, or left ventricular mass index between groups. Trivial or mild aortic regurgitation was found in 3.9% of patients with the conventional modified technique and 4.0% of patients undergoing the alternative technique, during follow-up (P > 0.05).
Compared to the conventional subcoronary implantation technique, the alternative subcoronary implantation technique reduces the incidence of new CHB and the requirement of PPI following AVR with stentless tissue valves while preserving mid-term hemodynamic function.
无支架主动脉瓣假体具有出色的血流动力学特征，但与传统假体相比，术后心脏传导阻滞可能增加。
评估一种替代性的冠状动脉下植入技术对无支架组织瓣膜主动脉瓣置换术（AVR）后术后完全性心脏传导阻滞（CHB）和永久性起搏器植入（PPI）的影响。
对一位外科医生连续进行的130例接受无支架组织瓣膜AVR的患者进行回顾性研究。
80例患者采用传统改良冠状动脉下植入技术植入无支架组织瓣膜，50例患者采用一种替代性冠状动脉下技术接受无支架组织瓣膜，其中流入缝线在右无冠状动脉交界水平处抬高。在出院时和术后6 - 12个月收集数据。
采用独立样本t检验比较连续变量，分类变量采用卡方检验进行比较。
使用这种新方法可降低术后CHB（4.0%对16.3%，P = 0.033），术后早期需要PPI的患者较少（6.0%对18.8%，P = 0.041）。超声心动图检查显示两组之间有效瓣口面积、主动脉瓣峰值和平均梯度或左心室质量指数无差异。随访期间，采用传统改良技术的患者中有3.9%发现轻微或轻度主动脉瓣反流，采用替代性技术的患者中有4.0%发现轻微或轻度主动脉瓣反流（P > 0.05）。
与传统冠状动脉下植入技术相比，替代性冠状动脉下植入技术在保留中期血流动力学功能的同时，降低了无支架组织瓣膜AVR后新发性CHB的发生率和PPI的需求。
