Domoto Satoru, Niinami Hiroshi, Uwabe Kazuhiko, Koike Hiroyuki, Tabata Mimiko, Morita Kozo, Kambe Masaru, Iguchi Atsushi
Department of Cardiovascular Surgery, Saitama International Medical Center, Saitama Medical University, Hidaka-shi, Saitama, Japan
Department of Cardiovascular Surgery, Saitama International Medical Center, Saitama Medical University, Hidaka-shi, Saitama, Japan.
Interact Cardiovasc Thorac Surg. 2016 Jan;22(1):19-25. doi: 10.1093/icvts/ivv284. Epub 2015 Oct 13.
A potential problem in aortic valve replacement (AVR) for patients with a small aortic annulus is prosthesis-patient mismatch (PPM). Although larger size prostheses have been well studied, the haemodynamics of 19-mm bioprostheses has been reported in only a small number of patients. The Trifecta valve is a novel bioprosthesis and its unique design is conceived to increase effective orifice area (EOA) and prevent PPM. This study aims at comparing the early haemodynamics of the new Trifecta valve with that of other conventional 19-mm valves.
We retrospectively evaluated 128 consecutive patients who underwent AVR with 19-mm bioprosthesis (39 Trifecta valve, 67 Magna Ease valve and 22 Mosaic Ultra valve) at Saitama International Medical Center between April 2012 and December 2014. Haemodynamics was evaluated by transthoracic echocardiography at 1 month after discharge and at 1-year follow-up.
The average body surface area of all patients was 1.37 m(2). There was no difference in postoperative clinical outcomes between the three groups. Among the three groups, the mean pressure gradient (MPG) was the smallest (10.6 ± 4.3 mmHg, P < 0.001) and the EOA was the largest (1.63 ± 0.36 cm(2), P < 0.001) in the Trifecta group at 1 month after discharge. In the Trifecta group, PPM was not observed (P < 0.001), the MPG was the smallest (12.8 ± 3.6 mmHg, P < 0.001) and the EOA was the largest (1.50 ± 0.30 cm(2), P < 0.001) at the 1-year follow-up.
The new 19-mm Trifecta valve showed favourable early haemodynamics compared with the conventional valves and may be useful for preventing PPM in patients with a small aortic annulus.
对于主动脉瓣环较小的患者，主动脉瓣置换术（AVR）中一个潜在问题是人工瓣膜-患者不匹配（PPM）。尽管较大尺寸的人工瓣膜已得到充分研究，但仅有少数患者报道过19毫米生物瓣膜的血流动力学情况。Trifecta瓣膜是一种新型生物瓣膜，其独特设计旨在增加有效瓣口面积（EOA）并预防PPM。本研究旨在比较新型Trifecta瓣膜与其他传统19毫米瓣膜的早期血流动力学情况。
我们回顾性评估了2012年4月至2014年12月期间在埼玉国际医疗中心接受19毫米生物瓣膜AVR的128例连续患者（39例Trifecta瓣膜、67例Magna Ease瓣膜和22例Mosaic Ultra瓣膜）。出院后1个月及1年随访时通过经胸超声心动图评估血流动力学。
所有患者的平均体表面积为1.37平方米。三组术后临床结局无差异。三组中，出院后1个月时Trifecta组的平均压力阶差（MPG）最小（10.6±4.3 mmHg，P<0.001），有效瓣口面积（EOA）最大（1.63±0.36平方厘米，P<0.001）。在Trifecta组，1年随访时未观察到PPM（P<0.001），MPG最小（12.8±3.6 mmHg，P<0.001），EOA最大（1.50±0.30平方厘米，P<0.001）。
新型19毫米Trifecta瓣膜与传统瓣膜相比显示出良好的早期血流动力学情况，可能有助于预防主动脉瓣环较小患者的PPM。
