Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh.
Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa.
J Thorac Cardiovasc Surg. 2019 Oct;158(4):1021-1027. doi: 10.1016/j.jtcvs.2018.11.028. Epub 2018 Nov 23.
Stentless bioprosthetic valves such as the Freestyle conduit have been widely used as an option for aortic root replacement in the setting of aortic root aneurysms with acceptable long-term outcomes. However, there is a paucity of data regarding the use of the Freestyle prosthesis in patients with aortic stenosis.
All patients with a primary diagnosis of severe aortic stenosis who underwent complete aortic root replacement with Freestyle conduits were included. Primary outcomes included survival and readmissions for heart failure. Secondary outcomes included immediate postoperative complications.
In total, 2529 patients with severe aortic stenosis who needed an open aortic valve replacement with a biological prosthesis were operated on between 2011 and 2017. Of these, 294 patients underwent aortic root replacements using the Freestyle conduit with a primary diagnosis of native or prosthetic aortic stenosis. Eighty-four (28.6%) of the patients underwent reoperative sternotomy. The majority (53.7%) of the cohort were men. The mean age was 67.5 ± 13.0 years. Mean Society of Thoracic Surgeons Predicted Risk of Mortality when calculated with the assumption of aortic valve replacement ± coronary artery bypass grafting was 8.10% ± 10.8. The median follow-up time for the entire group was 2.7 years (interquartile range 0.9-4.5 years). Operative (30-day) mortality was 7.1% (n = 21). Kaplan-Meier mortality estimates at 1 and 5 years are 16.6% and 27.6%, respectively. Mean gradients were 7.15 ± 4.47 mm Hg at 1 month and 6.32 ± 4.76 mm Hg at 1 year. Readmissions for heart failure at 30 days, 1 year, and 5 years were 5.6%, 11.8%, and 17.4%, respectively.
Aortic root replacement using Freestyle bioprostheses is a viable option for patients with severe aortic stenosis with low risk of hospital readmission for heart failure.
无支架生物瓣，如 Freestyle 管道，已被广泛用作治疗主动脉根部瘤合并主动脉瓣狭窄患者的主动脉根部置换术的选择之一，具有可接受的长期结果。然而，关于 Freestyle 假体在主动脉瓣狭窄患者中的应用的数据很少。
所有因严重主动脉瓣狭窄而接受 Freestyle 管道行主动脉根部置换术的患者均被纳入本研究。主要结局包括生存和因心力衰竭再入院。次要结局包括术后即刻并发症。
2011 年至 2017 年间，共有 2529 例严重主动脉瓣狭窄患者接受生物瓣主动脉瓣置换术，其中 294 例行 Freestyle 管道主动脉根部置换术，其主要诊断为原发性或人工主动脉瓣狭窄。84 例（28.6%）患者行再次正中开胸术。队列中大多数（53.7%）患者为男性。平均年龄为 67.5±13.0 岁。平均胸外科医生协会预测死亡率（当假设行主动脉瓣置换术+冠状动脉旁路移植术时）为 8.10%±10.8。全组中位随访时间为 2.7 年（四分位距 0.9-4.5 年）。全组手术（30 天）死亡率为 7.1%（n=21）。Kaplan-Meier 1 年和 5 年死亡率估计值分别为 16.6%和 27.6%。1 个月时平均梯度为 7.15±4.47mmHg，1 年时为 6.32±4.76mmHg。30 天、1 年和 5 年因心力衰竭再入院率分别为 5.6%、11.8%和 17.4%。
对于主动脉瓣狭窄风险低、因心力衰竭再入院风险低的患者，使用 Freestyle 生物瓣行主动脉根部置换术是一种可行的选择。
