Cardiac Surgery, Department of Cardiovascular Diseases, Katholieke Universiteit Leuven, Leuven, Belgium.
Cardiac Surgery, Department of Cardiovascular Diseases, Katholieke Universiteit Leuven, Leuven, Belgium.
J Thorac Cardiovasc Surg. 2014 Apr;147(4):1219-24. doi: 10.1016/j.jtcvs.2013.03.025. Epub 2013 Apr 25.
We examined the influence of multiple valve-related parameters on the onset and incidence of valve degeneration in aortic bioprostheses through detailed echocardiographic follow-up.
In 648 patients (mean age, 73.8 ± 4.9 years) receiving an aortic valve bioprosthesis, long-term clinical (mean, 7.5 ± 3.2 years) and echocardiographic (mean, 6.5 ± 3.4 years) follow-up were performed. The occurrence of signs of structural valve degeneration (stenosis type and regurgitation type) was studied through multivariate analysis, including tissue origin, design and label size of the prosthesis, effective orifice area index (EOAi), patient-prosthesis mismatch (PPM; EOAi <0.85 cm(2)/m(2)), and antimineralization treatment.
Structural valve degeneration (SVD) was diagnosed in 12.6% of patients. In 7.6%, it was of the stenosis type (S-SVD); in 5%, it was the regurgitation type (R-SVD). The absence of antimineralization treatment is an independent predictor of SVD, S-SVD, and R-SVD. Patient-prosthesis mismatch is an independent predictor of SVD and S-SVD, but not of R-SVD. Patients receiving a nontreated valve show a freedom of SVD at 10 years follow-up of 70.1 ± 4.3% versus 90.9 ± 3.6% in patients receiving a treated valve (P < .0001). Patients having PPM and receiving a nontreated valve show a freedom of SVD at 10 years of follow-up of only 59.8 ± 7.0% versus 88.7 ± 3.6% in patients also having PPM but receiving a treated valve (P < .0001). In patients not having PPM, the corresponding values were 78.0 ± 4.3% and 92.7 ± 3.4% for nontreated versus treated valves respectively (P = .01).
Antimineralization treatment of bioprosthetic heart valves is effective and reduces the incidence of SVD significantly. Because valve type and size are determined at the moment of implantation, the surgeon carries an important responsibility in protecting the patient from valve degeneration.
我们通过详细的超声心动图随访，研究了多个瓣膜相关参数对主动脉生物瓣置换术后瓣膜退行性变的发生和进展的影响。
在 648 例（平均年龄 73.8 ± 4.9 岁）接受主动脉瓣生物瓣置换术的患者中，进行了长期临床（平均 7.5 ± 3.2 年）和超声心动图（平均 6.5 ± 3.4 年）随访。通过多变量分析研究了结构性瓣膜退行性变（狭窄型和反流型）的发生情况，包括组织起源、瓣膜设计和标签尺寸、有效瓣口面积指数（EOAi）、患者-瓣膜不匹配（PPM；EOAi<0.85 cm²/m²）和抗钙化处理。
12.6%的患者诊断为结构性瓣膜退行性变（SVD）。其中 7.6%为狭窄型（S-SVD），5%为反流型（R-SVD）。未进行抗钙化处理是 SVD、S-SVD 和 R-SVD 的独立预测因素。PPM 是 SVD 和 S-SVD 的独立预测因素，但不是 R-SVD 的独立预测因素。未接受治疗的瓣膜患者 10 年随访时 SVD 无进展率为 70.1 ± 4.3%，而接受治疗的瓣膜患者为 90.9 ± 3.6%（P<0.0001）。PPM 且未接受治疗的患者 10 年随访时 SVD 无进展率仅为 59.8 ± 7.0%，而 PPM 且接受治疗的患者为 88.7 ± 3.6%（P<0.0001）。对于无 PPM 的患者，未接受治疗和接受治疗的瓣膜分别为 78.0 ± 4.3%和 92.7 ± 3.4%（P=0.01）。
生物瓣的抗钙化处理是有效的，可显著降低 SVD 的发生率。由于瓣膜类型和尺寸在植入时就已确定，因此外科医生在保护患者免受瓣膜退行性变方面负有重要责任。
