Kalender Mehmet, Fedakar Ali, Adademir Taylan, Salihi Salih, Boyacıoğlu Kamil, Özbek Babürhan, Taşar Mehmet, Balkanay Mehmet
Department of Cardiovascular Surgery, Konya Education and Research Hospital, Konya, Turkey.
Department of Cardiovascular Surgery, Kartal Kosuyolu Yuksek Ihtisas Education and Research Hospital, Istanbul, Turkey.
Kardiochir Torakochirurgia Pol. 2014 Dec;11(4):367-72. doi: 10.5114/kitp.2014.47334. Epub 2014 Nov 30.
In recent decades, new high-performance prostheses have been invented for use with small aortic annuli, and they have helped avoid patient prosthesis mismatch (PPM) without the need for aortic annular enlargement. The purpose of this study is to examine the trends in mechanical aortic valve replacement surgery in a large, multi-surgeon, single hospital practice.
Between January 1999 and January 2008, 1337 consecutive patients underwent aortic valve replacement (AVR) with or without concomitant aortic annulus enlargement. Patients with aortic dissections and patients undergoing Bentall and Ross procedures were excluded from the analysis. Patients were grouped according to the used aortic valve size. The data were collected and analyzed retrospectively.
The mean age of the subjects was 54.37 ± 17.35 (range: 10-84), and 881 of them were men (65.8%). The number of aortic root enlargement procedures decreased over the years (p < 0.05); particularly, the decline of the Nicks procedures was statistically significant (p < 0.05). In 2008, the most frequently used valve size was 23, which stands in contrast with the smaller size preferred in 1999 (p < 0.05). The primary pathophysiology leading to aortic valve replacement, i.e. aortic stenosis, did not change over the years (p > 0.05). Although the use of combined surgery increased in time, there was no statistical relationship with any increase in mortality rates (p > 0.05).
This study showed that avoiding the procedure of aortic root enlargement and implanting high-performance prostheses with larger valves is safe.
近几十年来，已发明了用于小型主动脉瓣环的新型高性能假体，它们有助于避免患者假体不匹配（PPM），而无需扩大主动脉瓣环。本研究的目的是在一个大型、多外科医生的单一医院实践中检查机械主动脉瓣置换手术的趋势。
1999年1月至2008年1月期间，1337例连续患者接受了主动脉瓣置换术（AVR），伴或不伴有主动脉瓣环扩大。主动脉夹层患者以及接受Bentall和Ross手术的患者被排除在分析之外。患者根据所用主动脉瓣大小分组。数据进行回顾性收集和分析。
受试者的平均年龄为54.37±17.35（范围：10 - 84岁），其中881例为男性（65.8%）。多年来主动脉根部扩大手术的数量有所减少（p < 0.05）；特别是，Nicks手术的下降具有统计学意义（p < 0.05）。2008年，最常用的瓣膜尺寸为23，这与1999年偏好的较小尺寸形成对比（p < 0.05）。导致主动脉瓣置换的主要病理生理学，即主动脉瓣狭窄，多年来没有变化（p > 0.05）。尽管联合手术的使用随时间增加，但与死亡率的任何增加均无统计学关系（p > 0.05）。
本研究表明，避免主动脉根部扩大手术并植入更大瓣膜的高性能假体是安全的。
