Department of Cardiac Surgery, Klinikum Nürnberg, Nuremberg, Germany.
Ann Thorac Surg. 2013 Jul;96(1):77-81; discussion 81-2. doi: 10.1016/j.athoracsur.2013.03.083. Epub 2013 May 11.
Sutureless aortic valve prostheses have the potential of shortening surgical time. However, whether shorter operative times may also result in improved patient outcomes remains to be established.
One hundred patients underwent minimally invasive isolated aortic valve replacement. Of these, 50 patients received a Perceval (Sorin Group, Saluggia, Italy) bioprosthesis (group P) and 50 patients received a non-Perceval valve (group NP).
The group P patients were older (77.5 ± 5.3 versus 71.7 ± 10 years, p = 0.001) and at higher risk (logistic European System for Cardiac Operative Risk Evaluation [EuroSCORE] 9.9 ± 6.5 versus 4.3 ± 1, p = 0.001) than group NP patients. One implant failure occurred in group P (p = 0.5), and conversion to full sternotomy was necessary in 1 patient from each group. Aortic cross-clamp and cardiopulmonary bypass times were 39.4% and 34% shorter in group P (both p < 0.001). Within 30 days, a total of 5 patients died (2 in group P and 3 in group NP, p = 0.5). No significant differences were observed between groups in postoperative arrhythmias and need for pacemaker implantation (p = 0.3 and p = 0.5, respectively). Despite the higher surgical risk, group P patients less frequently required blood transfusion (1.1 ± 1.1 units versus 2.3 ± 2.8 units, p = 0.007), and had a shorter intensive care unit stay (1.9 ± 0.7 versus 2.8 ± 1.9 days, p = 0.002) and a shorter intubation time (9.2 ± 3.6 hours versus 15 ± 13.8 hours, p = 0.01). Group NP patients had a mean prosthesis size significantly smaller than for group P (23 ± 2 mm versus 23.9 ± 1.1 mm, p = 0.01). The Perceval valve provided comparable hemodynamic performance to that of non-Perceval valves (mean gradient 8.4 ± 6 mm Hg versus 10 ± 4.9 mm Hg, p = 0.24).
Sutureless implantation of the Perceval valve is associated with shorter cross-clamp and cardiopulmonary bypass times, resulting in improved clinical outcome. In addition, it compares favorably with conventional valves in terms of mortality and outcome variables.
无缝线主动脉瓣假体有可能缩短手术时间。然而，手术时间的缩短是否也能带来患者预后的改善仍有待确定。
100 例患者接受了微创孤立主动脉瓣置换术。其中，50 例患者接受了 Perceval（Sorin Group，Saluggia，意大利）生物瓣（组 P），50 例患者接受了非 Perceval 瓣膜（组 NP）。
组 P 患者年龄较大（77.5±5.3 岁比 71.7±10 岁，p=0.001），风险较高（逻辑欧洲心脏手术风险评估系统[EuroSCORE]为 9.9±6.5 比 4.3±1，p=0.001）。组 P 中有 1 例植入失败（p=0.5），每组均有 1 例患者需要转为全胸骨切开术。组 P 的主动脉阻断和体外循环时间分别缩短了 39.4%和 34%（均 p<0.001）。术后 30 天内，共有 5 例患者死亡（组 P 2 例，组 NP 3 例，p=0.5）。组间术后心律失常和需要植入起搏器的发生率无显著差异（p=0.3 和 p=0.5）。尽管手术风险较高，但组 P 患者输血较少（1.1±1.1 单位比 2.3±2.8 单位，p=0.007），住重症监护病房的时间较短（1.9±0.7 天比 2.8±1.9 天，p=0.002），插管时间较短（9.2±3.6 小时比 15±13.8 小时，p=0.01）。组 NP 患者的假体尺寸明显小于组 P（23±2mm 比 23.9±1.1mm，p=0.01）。Perceval 瓣膜的血流动力学性能与非 Perceval 瓣膜相当（平均梯度 8.4±6mmHg 比 10±4.9mmHg，p=0.24）。
Perceval 瓣膜的无缝线植入与较短的主动脉阻断和体外循环时间相关，从而改善了临床结局。此外，它在死亡率和结局变量方面与传统瓣膜相比具有优势。
