Andreas Martin, Wallner Stephanie, Ruetzler Kurt, Wiedemann Dominik, Ehrlich Marek, Heinze Georg, Binder Thomas, Moritz Anton, Hiesmayr Michael J, Kocher Alfred, Laufer Guenther
Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.
Eur J Cardiothorac Surg. 2015 Oct;48(4):557-61. doi: 10.1093/ejcts/ezu466. Epub 2014 Dec 18.
Outcome of aortic valve replacement may be influenced by the choice of bioprosthesis. Pericardial heart valves are described to have a favourable haemodynamic profile compared with porcine valves, although the clinical notability of this finding is still controversially debated. Herein, we compared the long-term results of two commonly implanted bioprosthesis at a single centre.
All consecutive patients undergoing isolated aortic valve replacement with either a Carpentier-Edwards Magna pericardial prosthesis or a Medtronic Mosaic porcine prosthesis between 2002 and 2008 were analysed regarding preoperative characteristics, short- and long-term survival, valve-related complications and echocardiographic findings.
The Medtronic Mosaic was implanted in 163 patients and the Carpentier-Edwards Magna in 295 patients. The sizes of implanted valves were 22.4 ± 1.5 mm for the Mosaic and 21.8 ± 1.8 mm for the Magna (P = 0.001). The long-term survival rate was 76 and 56% after 5 and 10 years for the Medtronic Mosaic, which was comparable with the Carpentier-Edwards Magna (77 and 57%; P = 0.92). Overall long-term survival was comparable with an age- and sex-matched Austrian general population for both groups. Valve-related adverse events were similar between groups. The postoperative mean transvalvular gradient was significantly increased in the Mosaic group (24 ± 9 mmHg vs 17 ± 7 mmHg; P < 0.001).
Both types of aortic bioprostheses offer excellent results after isolated aortic valve replacement. Despite relevant differences in gradients, long-term survival was comparable with the expected normal survival for both bioprostheses. Patients with a porcine heart valve had a higher postoperative transvalvular gradient.
主动脉瓣置换术的结果可能受生物假体选择的影响。与猪瓣膜相比，心包心脏瓣膜具有良好的血流动力学特征，尽管这一发现的临床显著性仍存在争议。在此，我们在单一中心比较了两种常用植入生物假体的长期结果。
分析了2002年至2008年间所有连续接受单纯主动脉瓣置换术的患者，这些患者分别植入了Carpentier-Edwards Magna心包假体或Medtronic Mosaic猪假体，分析内容包括术前特征、短期和长期生存率、瓣膜相关并发症及超声心动图检查结果。
163例患者植入了Medtronic Mosaic，295例患者植入了Carpentier-Edwards Magna。Mosaic植入瓣膜的尺寸为22.4±1.5mm，Magna为21.8±1.8mm（P=0.001）。Medtronic Mosaic在5年和10年后的长期生存率分别为76%和56%，与Carpentier-Edwards Magna相当（77%和57%；P=0.92）。两组的总体长期生存率与年龄和性别匹配的奥地利普通人群相当。两组间瓣膜相关不良事件相似。Mosaic组术后平均跨瓣压差显著升高（24±9mmHg对17±7mmHg；P<0.001）。
两种类型的主动脉生物假体在单纯主动脉瓣置换术后均有出色的结果。尽管压差存在显著差异，但两种生物假体的长期生存率与预期正常生存率相当。植入猪心脏瓣膜的患者术后跨瓣压差更高。
