Belluschi Igor, Moriggia Stefano, Giacomini Andrea, Del Forno Benedetto, Di Sanzo Stefania, Blasio Andrea, Scafuri Antonio, Alfieri Ottavio
Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy.
Department of Cardiac Surgery, Tor Vergata University of Rome, Rome, Italy.
Eur J Cardiothorac Surg. 2017 Jun 1;51(6):1093-1099. doi: 10.1093/ejcts/ezx009.
The aim of this study is to compare the theoretical incidence of patient-prosthesis mismatch (PPM) in patients undergoing a sutureless or a sutured aortic valve replacement using an exact statistical matching.
Between May 2012 and March 2016, 65 patients with severe symptomatic aortic stenosis underwent a sutureless aortic valve replacement with the Perceval bioprosthesis in 2 centres. Moreover, 177 aortic valve replacements with conventional sutured bioprosthesis were performed between August 2003 and September 2015. Perceval and sutured patients were 1:1 exactly matched for sex and body surface area (BSA), resulting in 62 couples (sutureless: BSA 1.77 ± 0.16 m 2 , female 62.9% vs sutured: BSA 1.77 ± 0.15 m 2 , female 62.9%).
After matching, the indexed effective orifice area was 1.50 ± 0.18 cm 2 /m 2 and 0.81 ± 0.19 cm 2 /m 2 in the sutureless and the sutured group, respectively ( P < 0.001). No PPM occurred in patients who received a Perceval bioprosthesis ( n = 62). In the sutured group ( n = 62), 38 patients (61.3%) developed a PPM, which was moderate in 41.9% ( n = 26) and severe in 19.4% ( n = 12) ( P < 0.001).
The indexed effective orifice area of the sutureless group was significantly larger than in the sutured one. The incidence of PPM with the conventional sutured biprosthesis was 61.3%, while it decreases to 0% in the sutureless group. No PPM was reported in the sutureless valve group. Therefore, the Perceval sutureless valve provides larger effective orifice areas compared to the sutured conventional bioprosthesis and could be considered as a good option to reduce the risk of a PPM.
本研究旨在通过精确的统计匹配，比较接受无缝合或缝合主动脉瓣置换术患者的人工瓣膜-患者不匹配（PPM）的理论发生率。
2012年5月至2016年3月期间，65例有症状的严重主动脉瓣狭窄患者在2个中心接受了使用Perceval生物瓣膜的无缝合主动脉瓣置换术。此外，2003年8月至2015年9月期间进行了177例使用传统缝合生物瓣膜的主动脉瓣置换术。Perceval组和缝合组患者按性别和体表面积（BSA）进行1:1精确匹配，形成62对匹配组（无缝合组：BSA 1.77±0.16 m²，女性占62.9%；缝合组：BSA 1.77±0.15 m²，女性占62.9%）。
匹配后，无缝合组和缝合组的体表面积校正有效瓣口面积分别为1.50±0.18 cm²/m²和0.81±0.19 cm²/m²（P＜0.001）。接受Perceval生物瓣膜的患者未发生PPM（n = 62）。在缝合组（n = 62）中，38例患者（61.3%）发生了PPM，其中中度PPM占41.9%（n = 26），重度PPM占19.4%（n = 12）（P＜0.001）。
无缝合组的体表面积校正有效瓣口面积显著大于缝合组。传统缝合生物瓣膜的PPM发生率为61.3%，而无缝合组降至0%。无缝合瓣膜组未报告PPM。因此，与传统缝合生物瓣膜相比，Perceval无缝合瓣膜提供了更大的有效瓣口面积，可被视为降低PPM风险的良好选择。
