Operative Unit of Cardiac Surgery, G. Pasquinucci Hospital, G. Monasterio Foundation, Massa, Italy.
Operative Unit of Radiology, G. Pasquinucci Hospital, G. Monasterio Foundation, Massa, Italy.
Ann Thorac Surg. 2018 Jul;106(1):121-128. doi: 10.1016/j.athoracsur.2017.12.044. Epub 2018 Feb 2.
Significant underexpansion or distortion of valved stents may be associated with altered leaflet function, leading to increased transprosthetic gradients and, possibly, early structural degeneration. We investigated the relationship between a computed tomography measure of the degree of oversizing and the early hemodynamic and clinical outcomes in patients undergoing aortic valve replacement with the Perceval sutureless aortic valve (LivaNova, Saluggia, Italy).
The degree of oversizing of the implanted prosthesis was calculated as the ratio between the patients' aortic annulus cross-sectional area and the ex vivo cross-sectional area of the implanted prosthesis in 151 Perceval patients who underwent preoperative cardiac computed tomography. This value was then entered in a multivariate analysis to ascertain its role as a predictor of increased postoperative gradient.
The operative mortality was 1.3%. Procedural success, defined as having a normally functioning valve in the proper anatomical location, was achieved in 150 patients (99.3%). The mean transprosthetic gradient was 13.4 ± 5.0 mm Hg, and 23 patients (15.2%) showed a gradient of 20 mm Hg or more at discharge or at the 1-month follow-up. The degree of oversizing of the implanted prosthesis was the most important predictor of increased postoperative gradient (odds ratio, 1.264; 95% confidence interval, 1.147 to 1.394; p < 0.0001). Interestingly, other relevant factors (patients' body surface area, prosthesis size) were not associated with increased gradients.
Our study demonstrates that excessive oversizing should be avoided in Perceval patients and suggests that a different sizing algorithm, possibly based on cardiac computed tomography, should be developed. Further studies are needed to optimize the sizing strategy for the Perceval sutureless valve.
瓣膜支架的明显欠扩张或变形可能与瓣叶功能改变有关，导致跨瓣梯度增加，并可能导致早期结构性退化。我们研究了主动脉瓣置换术患者中经胸超声心动图测量的瓣架过度扩张程度与早期血流动力学和临床结局之间的关系。
在 151 例接受术前心脏计算机断层扫描的 Perceval 患者中，计算植入假体的瓣架过度扩张程度，方法为患者主动脉瓣环截面积与植入假体的离体截面积之比。然后将该值输入多变量分析，以确定其作为术后梯度增加的预测因子的作用。
手术死亡率为 1.3%。150 例患者（99.3%）达到了手术成功的标准，即具有正常功能的瓣膜位于适当的解剖位置。跨瓣梯度的平均值为 13.4±5.0mmHg，23 例（15.2%）在出院或 1 个月随访时的梯度为 20mmHg 或更高。植入假体的瓣架过度扩张程度是术后梯度增加的最重要预测因子（比值比，1.264；95%置信区间，1.147 至 1.394；p<0.0001）。有趣的是，其他相关因素（患者的体表面积、假体尺寸）与增加的梯度无关。
我们的研究表明，应避免 Perceval 患者过度扩张瓣架，并建议开发一种不同的尺寸选择算法，可能基于心脏计算机断层扫描。需要进一步的研究来优化 Perceval 无缝线瓣膜的尺寸选择策略。
