Uchida Tetsuro, Hamasaki Azumi, Kuroda Yoshinori, Nakamura Ken, Mizumoto Masahiro, Yamashita Atsushi, Hayashi Jun, Hirooka Shuto, Ishizawa Ai, Akabane Kentaro, Sadahiro Mitsuaki
Second Department of Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan.
Kyobu Geka. 2018 Nov;71(12):983-988.
The SOLO SMART valve is a bovine pericardial stentless bioprosthesis which shows superior hemodynamic performance compared to the stented valves. It is designed for supraannular and subcoronary implantation. We report our surgical experience and results in patients undergoing aortic valve replacement(AVR) with this new bioprosthesis.
Since June 2016, 19 patients with various types of aortic valve disease (mean age:72±7 years, 58% males) have undergone AVR with a SOLO SMART stentless bioprosthesis. Fourteen patients(74%)showed aortic stenosis( AS) and 9 patients(47%)had concomitant procedures;coronary bypass grafting (n=4), mitral valve surgery (n=3), total arch replacement (n=1), and pulmonary venous isolation( n=1). There was 1 patient with active infective valve endocarditis( IE) complicated with annular abscess and 1 patient was a redo AVR case. Surgical results of these patients were evaluated retrospectively. The hemodynamic performance was investigated with transthoracic echocardiography in pre and postoperative period.
There was no operative death and 1 hospital death (postoperative subdural hematoma;Heyde syndrome). One patient showed a mild trans-prosthetic valve leak. No patient required reoperation. Although postoperative transient thrombocytopenia was noted, it had cured at the time of discharge. At the last echocardiographic evaluation, the peak and mean gradients in the patients undergoing AVR for AS were 17±7 and 9±5 mmHg, respectively. No prosthesis-patient mismatch (PPM) occurred in any patient.
AVR using a SOLO SMART stentless bioprosthesis was performed with acceptable morbidity and mortality. The SOLO SMART stentless bioprosthesis showed excellent hemodynamic performance and early results. Because of favorable effective orifice area, the valve is attractive for patients at risk for PPM. Furthermore, it is expected to contribute to more complex AVR with concomitant mitral valve surgery, active IE or redo situation.
SOLO SMART瓣膜是一种牛心包无支架生物假体，与有支架瓣膜相比，其血流动力学性能更优。它设计用于瓣环上和冠状动脉下植入。我们报告了使用这种新型生物假体进行主动脉瓣置换术（AVR）患者的手术经验及结果。
自2016年6月以来，19例患有各种类型主动脉瓣疾病的患者（平均年龄：72±7岁，58%为男性）接受了使用SOLO SMART无支架生物假体的AVR手术。14例患者（74%）表现为主动脉瓣狭窄（AS），9例患者（47%）接受了同期手术；冠状动脉搭桥术（n = 4）、二尖瓣手术（n = 3）、全弓置换术（n = 1）和肺静脉隔离术（n = 1）。有1例活动性感染性心内膜炎（IE）合并瓣环脓肿患者，1例为再次AVR病例。对这些患者的手术结果进行了回顾性评估。在术前和术后通过经胸超声心动图研究血流动力学性能。
无手术死亡，1例医院死亡（术后硬膜下血肿；海德综合征）。1例患者出现轻度人工瓣膜反流。无患者需要再次手术。尽管术后出现短暂性血小板减少，但出院时已治愈。在最后一次超声心动图评估时，因AS接受AVR的患者的峰值和平均压差分别为17±7和9±5 mmHg。所有患者均未发生人工瓣膜-患者不匹配（PPM）。
使用SOLO SMART无支架生物假体进行AVR手术的发病率和死亡率可接受。SOLO SMART无支架生物假体显示出优异的血流动力学性能和早期结果。由于有效瓣口面积良好，该瓣膜对有PPM风险的患者具有吸引力。此外，预计它将有助于开展更复杂的AVR手术，包括同期二尖瓣手术、活动性IE或再次手术情况。
