Wollersheim Laurens W, Li Wilson W, Kaya Abdullah, Bouma Berto J, Driessen Antoine H, van Boven Wim J, van der Meulen Jan, de Mol Bas A
Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Semin Thorac Cardiovasc Surg. 2016;28(2):390-397. doi: 10.1053/j.semtcvs.2016.02.012. Epub 2016 Mar 2.
In patients with a small aortic root undergoing aortic valve replacement (AVR), the Freedom SOLO bioprosthesis may be the ideal prosthesis because of its stentless design and supra-annular implantation. This study investigated if the stentless Freedom SOLO has an advantage when compared with a stented bioprosthesis in patients with a small aortic root. From April 2005-July 2014, 269 consecutive patients underwent AVR with either a Freedom SOLO (n = 76) or Mitroflow (n = 193) bioprosthesis size 19mm or 21mm, respectively. This retrospective comparison study presents clinical and echocardiographic follow-up data. In results, operative outcome and survival were similar. At 7 years, cumulative incidence of aortic valve reoperation and structural valve deterioration favor the Freedom SOLO (0% vs 7.1%, P = 0.03 and 0% vs 4.5%, P = 0.08, respectively). Additionally, the postoperative peak and mean valvular gradients favor the Freedom SOLO (21 ± 9mmHg vs 32 ± 12mmHg and 12 ± 5mmHg vs 19 ± 8mmHg, both P = <0.001, respectively). During mid-term follow-up this hemodynamic advantage continued in favor of the Freedom SOLO. Also prosthesis-patient mismatch occurred less frequently in the Freedom SOLO (28% vs 52%, P = 0.001). There were no differences in prosthetic valve endocarditis, thromboembolic, or bleeding events. In conclusion, the stentless Freedom SOLO has several significant advantages for AVR in patients with a small aortic root in comparison with a stented Mitroflow bioprosthesis. The Freedom SOLO shows superior hemodynamic performance with significantly lower valvular gradients that remained stable during mid-term follow-up. Additionally, significantly fewer prosthesis-patient mismatch occurred and the Freedom SOLO showed superior durability.
在主动脉根部较小的患者中进行主动脉瓣置换（AVR）时，Freedom SOLO生物瓣膜因其无支架设计和瓣环上植入方式可能是理想的瓣膜。本研究调查了在主动脉根部较小的患者中，与有支架生物瓣膜相比，无支架的Freedom SOLO瓣膜是否具有优势。从2005年4月至2014年7月，269例连续患者分别接受了尺寸为19mm或21mm的Freedom SOLO瓣膜（n = 76）或Mitroflow瓣膜（n = 193）的AVR手术。这项回顾性比较研究展示了临床和超声心动图随访数据。结果显示，手术结果和生存率相似。在7年时，主动脉瓣再次手术和瓣膜结构退化的累积发生率有利于Freedom SOLO瓣膜（分别为0%对7.1%，P = 0.03；0%对4.5%，P = 0.08）。此外，术后峰值和平均瓣膜压差有利于Freedom SOLO瓣膜（分别为21±9mmHg对32±12mmHg以及12±5mmHg对19±8mmHg，两者P均<0.001）。在中期随访期间，这种血流动力学优势持续有利于Freedom SOLO瓣膜。而且Freedom SOLO瓣膜中人工瓣膜与患者不匹配的情况发生频率更低（28%对52%，P = 0.001）。人工瓣膜心内膜炎、血栓栓塞或出血事件方面没有差异。总之，与有支架的Mitroflow生物瓣膜相比，无支架的Freedom SOLO瓣膜在主动脉根部较小的患者进行AVR时有几个显著优势。Freedom SOLO瓣膜显示出卓越的血流动力学性能，瓣膜压差显著更低，且在中期随访期间保持稳定。此外，人工瓣膜与患者不匹配的情况显著更少，并且Freedom SOLO瓣膜显示出卓越的耐用性。
