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爱德华兹Intuity Elite和索林Perceval S快速部署主动脉瓣膜的直接比较。

Direct Comparison of the Edwards Intuity Elite and Sorin Perceval S Rapid Deployment Aortic Valves.

作者信息

Liakopoulos Oliver J, Gerfer Stephen, Weider Simone, Rahmanian Parwis, Zeriouh Mohamed, Eghbalzadeh Kaveh, Sabashnikov Anton, Choi Yeong-Hoon, Wippermann Jens, Wahlers Thorsten

机构信息

Department of Cardiothoracic Surgery, Heart Center of the University Hospital of Cologne, Cologne, Germany.

Department of Cardiothoracic Surgery, Heart Center of the University Hospital of Cologne, Cologne, Germany.

出版信息

Ann Thorac Surg. 2018 Jan;105(1):108-114. doi: 10.1016/j.athoracsur.2017.06.034. Epub 2017 Oct 14.

Abstract

BACKGROUND

Rapid deployment aortic valve replacement (RDAVR) has emerged as an attractive alternative to conventional aortic valve replacement. This single-center study directly compared two commercially available rapid deployment valves with regard to clinical outcomes, valve-related complications, and hemodynamic performance.

METHODS

A total of consecutive 156 patients underwent RDAVR with the Intuity Elite (Edwards Lifesciences, Irvine, CA [Intuity group, n = 117] or the Perceval S (Sorin Group Italia Srl, Saluggia, Italy [Perceval group, n = 39]) between September 2012 and March 2016 at our institution. Perioperative data, including 30-day all-cause mortality, and echocardiographic measurements were assessed and retrospectively analyzed from our institutional database.

RESULTS

Preoperative variables, including mean age (77 ± 5 years), European System for Cardiac Operative Risk Evaluation (6.8 ± 2.1), and body mass index (27 ± 5 kg/m), did not differ between groups. More male patients (60% versus 15%) with a higher body surface area (1.9 ± 0.2 m versus 1.7 ± 0.2 m) and body weight (78 ± 13 kg versus 71 ± 15 kg) were in the Intuity group compared with the Perceval group, respectively (p < 0.05). Implanted RDAVR size (23.3 ± 1.8 mm versus 23.4 ± 1.5 mm), concomitant coronary artery bypass graft surgery (48% versus 33%), number of grafts, cardiopulmonary bypass, and aortic clamp time were comparable between the Intuity group and the Perceval group. Thirty-day mortality (Intuity 2.6% versus Perceval 5.1%) and valve-related complications (Intuity 12.0% versus Perceval 20.5%), including postoperative pacemaker implantation (Intuity 8.5% versus Perceval 12.8%), did not differ between groups. At discharge echocardiography, indexed effective orifice area was higher in the Intuity group, but peak or mean pressure gradients were comparable between groups.

CONCLUSIONS

Performing RDAVR with the Intuity and Perceval rapid deployment valves provides comparable good clinical outcomes and valve hemodynamics, with low valve-related complication rates. The rate of pacemaker implantation was comparable for both rapid deployment valves, ranging from 8% to 13%.

摘要

背景

快速部署主动脉瓣置换术(RDAVR)已成为传统主动脉瓣置换术的一种有吸引力的替代方案。这项单中心研究直接比较了两种市售快速部署瓣膜的临床结果、瓣膜相关并发症和血流动力学性能。

方法

2012年9月至2016年3月期间,共有156例连续患者在本机构接受了使用Intuity Elite(爱德华生命科学公司,加利福尼亚州欧文市[Intuity组,n = 117])或Perceval S(索林集团意大利有限公司,意大利萨卢贾[Perceval组,n = 39])的RDAVR。围手术期数据,包括30天全因死亡率和超声心动图测量值,均从我们的机构数据库中进行评估和回顾性分析。

结果

术前变量,包括平均年龄(77±5岁)、欧洲心脏手术风险评估系统(6.8±2.1)和体重指数(27±5 kg/m²),两组之间无差异。与Perceval组相比,Intuity组男性患者更多(60%对15%),体表面积更高(1.9±0.2 m²对1.7±0.2 m²),体重更重(78±13 kg对71±15 kg)(p < 0.05)。Intuity组和Perceval组植入的RDAVR尺寸(23.3±1.8 mm对23.4±1.5 mm)、同期冠状动脉搭桥手术(48%对33%)、移植血管数量、体外循环和主动脉阻断时间相当。30天死亡率(Intuity组为2.6%,Perceval组为5.1%)和瓣膜相关并发症(Intuity组为12.0%,Perceval组为20.5%),包括术后起搏器植入(Intuity组为8.5%,Perceval组为12.8%),两组之间无差异。出院时超声心动图显示,Intuity组的指数有效瓣口面积较高,但两组之间的峰值或平均压力梯度相当。

结论

使用Intuity和Perceval快速部署瓣膜进行RDAVR可提供相当良好的临床结果和瓣膜血流动力学,瓣膜相关并发症发生率较低。两种快速部署瓣膜的起搏器植入率相当,在8%至13%之间。

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