Cardiovascular Surgery Unit, Cardiovascular Diseases Department, University Hospital, St-Etienne, France.
Cardiovascular Surgery Unit, Salus Hospital GVM Care & Research, Reggio Emilia, Italy.
J Thorac Cardiovasc Surg. 2015 Apr;149(4):1052-7. doi: 10.1016/j.jtcvs.2014.12.017. Epub 2014 Dec 18.
A sutureless aortic valve can be inserted through a right anterior minithoracotomy (RAMT) with consistent decreased cross-clamping time and ease of insertion. We report the experience of RAMT implantation of the 3f Enable (Medtronic, Inc, Minneapolis, Minn) self-expanding sutureless bioprosthesis, performed in 2 European cardiac surgery centers.
From September 2012 to April 2014, a total of 71 patients with severe aortic stenosis were selected to receive an aortic valve replacement via RAMT using the sutureless valve. Hemodynamic parameters and clinical outcome were assessed at discharge and up to 16 months postoperatively.
All the patients received the prosthesis with success. One conversion to median sternotomy was necessary, owing to severe pleural adhesions. Overall in-hospital mortality was 2.8%. Mean cardiopulmonary bypass and cross-clamping time were, respectively, 91 ± 29 minutes and 66 ± 19 minutes. Reclamping was necessary in 4 cases (5.6%). Early incidences of grade I or lower paravalvular leakages and pacemaker implantation were, respectively, 4.2% and 5.6%. No paravalvular leakage greater than grade I was registered. The mean follow-up time was 8.1 months; the mean transvalvular gradient was, at discharge and at 6-12 months, respectively, 10.7 ± 4.3 mm Hg and 9.6 ± 3.1 mm Hg. The degree of regurgitation remained stable in all cases. Freedom from all-cause and valve-related mortality was 97% and 99%, respectively, at 1 year.
Aortic valve replacement via RAMT with the 3f Enable valve is a reproducible procedure, as it provides satisfactory hemodynamics, and a low valve-related complication rate. Greater experience is needed to compare the performance of the 3f Enable valve with that of other sutureless valves implanted via the same RAMT procedure.
通过右前小开胸（RAMT）可以插入无缝线主动脉瓣，其夹闭时间明显缩短，且易于插入。我们报告在欧洲的 2 家心脏外科中心使用经 RAMT 植入 3f Enable（美敦力公司，明尼苏达州明尼阿波利斯）自膨式无缝线生物瓣的经验。
从 2012 年 9 月至 2014 年 4 月，共有 71 例严重主动脉瓣狭窄患者选择通过 RAMT 植入无缝线瓣膜行主动脉瓣置换术。在出院时和术后 16 个月评估血流动力学参数和临床结果。
所有患者均成功植入假体。由于严重的胸膜粘连，有 1 例需要转为正中开胸。总的院内死亡率为 2.8%。平均体外循环和夹闭时间分别为 91±29 分钟和 66±19 分钟。有 4 例（5.6%）需要再次夹闭。早期发生 1 级或以下瓣周漏和植入起搏器的发生率分别为 4.2%和 5.6%。无大于 1 级的瓣周漏。平均随访时间为 8.1 个月；出院时和 6-12 个月时的平均跨瓣梯度分别为 10.7±4.3mmHg 和 9.6±3.1mmHg。所有病例的反流程度均保持稳定。1 年时全因死亡率和瓣膜相关死亡率分别为 97%和 99%。
通过 RAMT 植入 3f Enable 瓣膜行主动脉瓣置换术是一种可重复的方法，因为它可提供满意的血流动力学和较低的瓣膜相关并发症发生率。需要更多的经验来比较 3f Enable 瓣膜与通过相同 RAMT 手术植入的其他无缝线瓣膜的性能。
