使用Perceval S生物瓣膜进行主动脉瓣置换术：143例患者的单中心经验。

Aortic valve replacement with the perceval S bioprosthesis: single-center experience in 143 patients.

作者信息

Zannis Konstantinos, Joffre Jérémie, Czitrom Daniel, Folliguet Thierry, Noghin Milena, Lansac Milena Noghin Emmanuel, Mitchell-Heggs Laurens, Debauchez Mathieu, Laborde Francois

出版信息

J Heart Valve Dis. 2014 Nov;23(6):795-802.

PMID:25790630

Abstract

BACKGROUND AND AIM OF THE STUDY

Aortic stenosis (AS) is the most frequent heart valve disease in western countries, and its prevalence increases with age. Sutureless valves have recently become available that allow the surgical procedures to be shortened. The study aim was to assess clinical outcome after sutureless aortic valve replacement (SAVR) performed with the Perceval S bioprosthesis at the authors' institution.

METHODS

Between June 2007 and November 2011, a total of 143 patients (78 females, 65 males; mean age 79.4 +/- 5.9 years) was prospectively enrolled and followed at the authors' center. The median preoperative logistic EuroSCORE was 12.04 +/- 10.7. Preoperatively, 58.8% of patients were in NYHA class III or IV, and the mean gradient and effective orifice area (EOA) were 38.8 +/- 17 mmHg and 0.76 +/- 0.24 cm2, respectively. Isolated SAVR was performed in 95 patients (66.4%), while associated procedures were necessary in 48 patients (33.6%). The follow up was 100% complete (mean 13.4 +/- 11.6 months; range: 0-5 years; total cumulative follow up 155 patient-years).

RESULTS

The procedural success rate was 99.3%. The mean cross-clamp and cardiopulmonary bypass times were 32.0 +/- 14.9 min and 44.7 +/- 18.6 min, respectively. In-hospital mortality was 4.9% (n=7). Pacemaker implantation was required in seven patients (4.9%). Survival at five years was 85.5%. Reoperation was necessary in seven patients (4.9%); early reoperations were due to paravalvular leak (n = 3; 2.0%) and intra-prosthetic regurgitation (n=3; 2.0%). One late reoperation (at 29 months) was required, due to fibrous pannus overgrowth. One late endocarditis (0.7%) occurred at 26 months and was medically treated. No structural valve deterioration occurred during the follow up. At 12 months, 94.4% of survivors were in NYHA class I-II, and the mean pressure gradient and EOA were 9.0 +/- 3.4 mmHg and 1.60 +/- 0.3 cm2, respectively.

CONCLUSION

The Perceval S valve appears to be a safe option for SAVR, though further follow up is needed to evaluate the long-term outcome with this bioprosthesis.

摘要

研究背景与目的

在西方国家，主动脉瓣狭窄（AS）是最常见的心脏瓣膜疾病，且其患病率随年龄增长而增加。最近出现了无需缝合的瓣膜，可缩短手术时间。本研究的目的是评估在作者所在机构使用Perceval S生物瓣膜进行无缝合主动脉瓣置换术（SAVR）后的临床结果。

方法

2007年6月至2011年11月期间，作者所在中心前瞻性纳入并随访了143例患者（78例女性，65例男性；平均年龄79.4±5.9岁）。术前逻辑EuroSCORE中位数为12.04±10.7。术前，58.8%的患者为纽约心脏协会（NYHA）III或IV级，平均压力阶差和有效瓣口面积（EOA）分别为38.8±17 mmHg和0.76±0.24 cm²。95例患者（66.4%）接受了单纯SAVR，48例患者（33.6%）需要进行相关手术。随访率为100%（平均13.4±11.6个月；范围：0 - 5年；总累积随访155患者年）。

结果

手术成功率为99.3%。平均主动脉阻断时间和体外循环时间分别为32.0±14.9分钟和44.7±18.6分钟。住院死亡率为4.9%（n = 7）。7例患者（4.9%）需要植入起搏器。五年生存率为85.5%。7例患者（4.9%）需要再次手术；早期再次手术原因是瓣周漏（n = 3；2.0%）和人工瓣膜反流（n = 3；2.0%）。1例晚期再次手术（29个月时）是由于纤维性赘生物过度生长。1例晚期心内膜炎（0.7%）发生在26个月时，经药物治疗。随访期间未发生结构性瓣膜退变。12个月时，94.4%的存活患者为NYHA I - II级，平均压力阶差和EOA分别为9.0±3.4 mmHg和1.60±0.3 cm²。