Stock Sina, Lohmann Inga, Hanke Thorsten, Stierle Ulrich, Richardt Doreen, Tsvelodub Stanislav, Sievers Hans-Hinrich
Department of Cardiac and Thoracic Vascular Surgery, University of Luebeck, Luebeck, Germany.
Interact Cardiovasc Thorac Surg. 2018 Mar 1;26(3):425-430. doi: 10.1093/icvts/ivx356.
Because bioprosthetic aortic valve replacement remains one of the most frequent cardiac surgical procedures, it is necessary to study patient haemodynamics in more detail. Until now, a few studies assessed haemodynamics during exercise, but none with special regard to small aortic annuli. We compared patients who had the differently designed bioprostheses, Trifecta and Perimount Magna Ease (PME), size ≤ 23 mm, and a healthy control group during rest and exercise.
We determined the mean transvalvular gradient, the effective orifice area (EOA) and the EOA index during rest and exercise using transthoracic echocardiography in 35 patients with the Trifecta (mean age 71.4 years, follow-up 1 year, labelled valve size 21.7 mm), in 16 patients with the PME (mean age 66.2 years, follow-up 2.6 years, labelled valve size 21.6 mm) and in 25 healthy persons. The parameters derived were summarized in a simplified Valve Academic Research Consortium-2 classification to determine prosthetic valve dysfunction.
When we compared the Trifecta and the PME, a significant superiority of the Trifecta was seen at rest in mean transvalvular gradient (7.96 vs 12.19 mmHg) and EOA (1.57 vs 1.48 cm2), during exercise in all parameters (mean transvalvular gradient 11.06 vs 19.2 mmHg, EOA 1.77 vs 1.26 cm2, EOA index 0.96 vs 0.67 cm2/m2). The Trifecta showed a physiological increase in the EOA index during exercise. Exercise led to a shift to better simplified Valve Academic Research Consortium-2 categories in the Trifecta and to worse in the PME group.
This study reveals the haemodynamic superiority of the Trifecta to the PME. Especially in small aortic annuli, this difference might have some relevance for clinical and research issues.
由于生物人工主动脉瓣置换术仍是最常见的心脏外科手术之一，因此有必要更详细地研究患者的血流动力学。到目前为止，有一些研究评估了运动期间的血流动力学，但没有一项特别关注小主动脉瓣环。我们比较了植入不同设计的生物人工瓣膜（Trifecta和Perimount Magna Ease，PME）、尺寸≤23mm的患者以及健康对照组在静息和运动状态下的情况。
我们使用经胸超声心动图，测定了35例植入Trifecta瓣膜的患者（平均年龄71.4岁，随访1年，标记瓣膜尺寸21.7mm）、16例植入PME瓣膜的患者（平均年龄66.2岁，随访2.6年，标记瓣膜尺寸21.6mm）以及25名健康人的静息和运动状态下的平均跨瓣压差、有效瓣口面积（EOA）和EOA指数。得出的参数按照简化的瓣膜学术研究联盟-2分类进行汇总，以确定人工瓣膜功能障碍。
当我们比较Trifecta和PME时，发现Trifecta在静息时平均跨瓣压差（7.96对12.19mmHg）和EOA（1.57对1.48cm²）方面具有显著优势，在运动时所有参数（平均跨瓣压差11.06对19.2mmHg，EOA 1.77对1.26cm²，EOA指数0.96对0.67cm²/m²）均具有显著优势。Trifecta在运动时EOA指数呈现生理性增加。运动导致Trifecta组的简化瓣膜学术研究联盟-2分类向更好的方向转变，而PME组则向更差的方向转变。
本研究揭示了Trifecta相对于PME在血流动力学方面的优势。特别是在小主动脉瓣环中，这种差异可能对临床和研究问题具有一定的相关性。
