Division of Cardiac Surgery, Quebec Heart and Lung University Institute, 2725 Chemin Ste-Foy, Quebec City, Quebec, Canada G1V 4G5.
Circulation. 2012 Sep 11;126(11 Suppl 1):S198-204. doi: 10.1161/CIRCULATIONAHA.111.084806.
Stentless aortic bioprostheses were designed to provide enhanced hemodynamic performance and potentially greater longevity. The present report describes the outcomes of patients with the Freestyle stentless bioprosthesis followed for ≤18 years.
Between 1993 and 2011, 430 patients underwent primary aortic valve replacement with a Freestyle bioprosthesis in the subcoronary position. Mean age was 68.2 ± 8.2 years. All of the clinical and echocardiographic data were collected prospectively. Mean overall follow-up was 9.1 ± 4.4 years and was complete in all of the patients. In-hospital mortality was 3.5% (n=15). Overall, 10- and 15-year survival were 60.7% and 35.0%, respectively. Fifty-one patients required reoperation during follow-up, including 27 for structural valve deterioration (SVD). Overall, freedom from reoperation was 91.0% and 75.0% at 10 and 15 years, whereas freedom from reoperation for SVD was 95.9% and 82.3%, respectively. At 10 and 15 years, freedom from reoperation for SVD was 94.0% and 62.6% for patients <60 years of age and 96.3% and 88.4% for patients ≥60 years of age (P=0.002). The median time to explant for SVD was 10.7 years. SVD presented mostly as acute, severe aortic insufficiency attributed to leaflet tear (77.8%). The independent risk factors for reoperation for SVD were age <60 years (P=0.001) and dyslipidemia (P=0.02).
Aortic valve replacement with the Freestyle bioprosthesis in a subcoronary position provides good long-term clinical and echocardiographic outcomes for patients >60 years of age. Severe aortic insufficiency with leaflet tear is the major mode of SVD leading to reoperation in these patients.
无支架生物主动脉瓣旨在提供增强的血液动力学性能，并可能具有更长的使用寿命。本报告描述了接受亚冠状动脉位置的 Freestyle 无支架生物瓣置换术的患者随访 ≤18 年的结果。
1993 年至 2011 年期间，430 例患者在亚冠状动脉位置接受 Freestyle 生物瓣置换术进行原发性主动脉瓣置换。平均年龄为 68.2 ± 8.2 岁。所有临床和超声心动图数据均前瞻性收集。平均总随访时间为 9.1 ± 4.4 年，所有患者均完成随访。住院死亡率为 3.5%（n=15）。总体而言，10 年和 15 年生存率分别为 60.7%和 35.0%。51 例患者在随访期间需要再次手术，其中 27 例因结构性瓣膜退化（SVD）而再次手术。总体而言，10 年和 15 年时无再手术率分别为 91.0%和 75.0%，而 SVD 无再手术率分别为 95.9%和 82.3%。10 年和 15 年时，<60 岁患者的 SVD 无再手术率分别为 94.0%和 62.6%，≥60 岁患者的 SVD 无再手术率分别为 96.3%和 88.4%（P=0.002）。SVD 患者的中位瓣膜置换时间为 10.7 年。SVD 主要表现为急性、严重主动脉瓣关闭不全，归因于瓣叶撕裂（77.8%）。SVD 再次手术的独立危险因素为年龄<60 岁（P=0.001）和血脂异常（P=0.02）。
在亚冠状动脉位置行 Freestyle 生物瓣置换术可为>60 岁患者提供良好的长期临床和超声心动图结果。这些患者中，瓣叶撕裂导致严重主动脉瓣关闭不全是 SVD 导致再次手术的主要模式。
