Doss Mirko, Buhr Estelle, Moritz Anton, Martens Sven
Division of Cardiothoracic Surgery, Johann Wolfgang Goethe, University, Frankfurt/Main, Germany.
J Heart Valve Dis. 2012 Nov;21(6):758-63.
Catheter-based aortic valve implantation leaves the calcified native leaflets in the aortic root. Upon valve deployment, the leaflets are pushed to the side, potentially compromising coronary perfusion, exerting pressure on the conduction system, and limiting the maximum effective orifice area. The study aim was to evaluate the perioperative outcome of an alternative self-expanding sutureless valve that is inserted via a conventional aortotomy, allowing for complete debridement of any calcified native aortic leaflets and annulus.
A total of 56 patients, all of which required bioprosthetic valve replacement for aortic valve stenosis, was included in the study. Twenty-nine patients underwent isolated catheter-based transapical aortic valve implantation using the Edwards SAPIEN prosthesis, while 27 patients underwent direct transaortic valve replacement, using the self-expandable ATS 3F Enable prosthesis. Implantation of the latter device utilized cardiopulmonary bypass (CPB), such that debridement of the calcified native leaflets was possible in all cases. The in-hospital echocardiographic findings and routine blood laboratory parameters of all patients were evaluated to determine the clinical outcome.
The 30-day mortality was 17% in the transapical group and 11% in the transaortic group. Two conversions were performed in each group. One valve migration, one complete heart block and two cases of coronary obstruction occurred in the transapical group. The implantation times were 8 min in the transapical group and 10 min in the transaortic group. Four paravalvular leaks occurred in the transapical group, but none occurred in the transaortic group.
Aortic valve replacement can be performed safely using either sutureless device. The transaortic approach has the additional advantage of allowing for the resection of native leaflets and for the performance of concomitant procedures. Laboratory investigations demonstrated an elevated creatine kinase MB fraction in the transapical group and comparable inflammatory parameters between groups, despite the use of CPB in the transaortic group.
基于导管的主动脉瓣植入术会使钙化的自体瓣叶留在主动脉根部。在瓣膜展开时，瓣叶被推到一侧，这可能会影响冠状动脉灌注，对传导系统施加压力，并限制最大有效瓣口面积。本研究的目的是评估一种替代性的经传统主动脉切开术植入的自膨胀无缝合瓣膜的围手术期结果，该瓣膜可对任何钙化的自体主动脉瓣叶和瓣环进行彻底清创。
本研究共纳入56例均因主动脉瓣狭窄需要进行生物瓣膜置换的患者。29例患者使用爱德华兹SAPIEN假体进行了单纯经导管经尖主动脉瓣植入术，而27例患者使用可自膨胀的ATS 3F Enable假体进行了直接经主动脉瓣膜置换术。植入后一种装置使用了体外循环（CPB），因此在所有病例中都能够对钙化的自体瓣叶进行清创。对所有患者的院内超声心动图检查结果和常规血液实验室参数进行评估，以确定临床结果。
经尖组的30天死亡率为17%，经主动脉组为11%。每组均进行了2次转换。经尖组发生了1次瓣膜移位、1次完全性心脏传导阻滞和2例冠状动脉阻塞。经尖组的植入时间为8分钟，经主动脉组为10分钟。经尖组发生了4例瓣周漏，但经主动脉组未发生。
使用任何一种无缝合装置都可以安全地进行主动脉瓣置换。经主动脉入路具有额外的优势，即可以切除自体瓣叶并进行同期手术。实验室检查显示，尽管经主动脉组使用了CPB，但经尖组的肌酸激酶MB同工酶升高，两组的炎症参数相当。
