Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
Ann Thorac Surg. 2012 Jun;93(6):1868-74; discussion 1874-5. doi: 10.1016/j.athoracsur.2012.01.061. Epub 2012 Mar 20.
Pericardial bioprostheses have favorable echocardiographic hemodynamics in the aortic position compared with porcine valves; however, there are few data comparing clinical outcomes. Our objective was to assess the late results of the two valve types.
We reviewed 2,979 patients aged 65 years or older undergoing aortic valve replacement with pericardial (n=1,976) or porcine (n=1,003) prostheses between January 1993 and December 2007. The most common pericardial prostheses were Carpentier-Edwards Perimount and Mitroflow, and the most common porcine valves were Medtronic Mosaic, Carpentier-Edwards, Hancock modified orifice, and St. Jude Biocor. Follow-up extended to a maximum of 16 years (mean, 5.2±3.5 years).
Survival at 5, 10 and 12 years was, respectively, 68%, 33%, and 21% overall, was 68%, 30%, and 16% for patients with pericardial bioprosthesis, and was 69%, 38% and 27% for the porcine group. In a multivariate model, long-term survival was reduced in patients with diabetes, renal failure, prior myocardial infarction, congestive heart failure, and older age, but late survival was not higher in the pericardial valve group. Overall freedom from reoperation was 96%, 92%, and 90% at 5, 10, and 12 years, and freedom from explant was 98%, 96%, and 94% during the same period. The reason for explant was structural valve deterioration in 50 patients (2%).
Despite the better hemodynamic performance documented in prior investigations, pericardial valves do not confer any survival advantage over porcine valves in patients aged 65 years or older undergoing aortic valve replacement.
与猪瓣膜相比，心包生物瓣在主动脉瓣位置具有更好的超声心动图血流动力学，但关于临床结果的比较数据较少。我们的目的是评估这两种瓣膜类型的晚期结果。
我们回顾了 1993 年 1 月至 2007 年 12 月期间，2979 例年龄在 65 岁或以上的患者行主动脉瓣置换术，其中 1976 例使用心包生物瓣，1003 例使用猪瓣。最常用的心包生物瓣是 Carpentier-Edwards Perimount 和 Mitroflow，最常用的猪瓣是 Medtronic Mosaic、Carpentier-Edwards、Hancock 改良瓣口和 St. Jude Biocor。随访时间最长可达 16 年（平均 5.2±3.5 年）。
总体而言，5 年、10 年和 12 年的生存率分别为 68%、33%和 21%，心包生物瓣组患者分别为 68%、30%和 16%，猪瓣组患者分别为 69%、38%和 27%。在多变量模型中，患有糖尿病、肾衰竭、既往心肌梗死、充血性心力衰竭和年龄较大的患者长期生存率降低，但心包瓣组的晚期生存率并未更高。总体而言，5 年、10 年和 12 年的再次手术无失败率分别为 96%、92%和 90%，同期的瓣膜取出无失败率分别为 98%、96%和 94%。瓣膜取出的原因是 50 例（2%）结构性瓣膜退化。
尽管先前的研究证明心包瓣在血流动力学性能方面表现更好，但在接受主动脉瓣置换术的 65 岁或以上患者中，心包瓣并不比猪瓣具有生存优势。
