Hartrumpf Martin, Kuehnel Ralf-Uwe, Schroeter Filip, Haase Robert, Laux Magdalena L, Ostovar Roya, Albes Johannes M
Department of Cardiovascular Surgery, Heart Center Brandenburg, Brandenburg Medical School, University Hospital Bernau, Bernau bei Berlin, Germany.
Thorac Cardiovasc Surg. 2020 Oct;68(7):557-566. doi: 10.1055/s-0038-1676853. Epub 2019 Jan 22.
Conventional stented valves (CV) remain gold standard for aortic valve disease. Bovine prostheses have been improved and rapid deployment valves (RDV) have arrived in the recent decade. We compare clinical and hemodynamic short-term outcome of six bovine valves.
We retrospectively evaluated 829 consecutive patients (all-comers) receiving bovine aortic valve replacement (AVR). Four CV from different manufacturers (Mitroflow, Crown, Perimount, Trifecta) and two RDV (Perceval, Intuity) were compared in terms of pre-, intra-, and postprocedural data. A risk model for mortality was created.
All valves reduced gradients. From 23 mm, all CV showed acceptable gradients. Twenty-one millimeter Mitroflow/Perceval and 19 mm Crown showed above-average gradients. As baseline data differed, we performed propensity matching between aggregated isolated CV and RDV groups. Cardiopulmonary bypass (CPB), clamp, and surgery times were shorter with RDV (87.4 ± 34.0 min vs 111.0 ± 34.2, 54.3 ± 21.1 vs 74.9 ± 20.4, 155.2 ± 42.9 vs 178.0 ± 46.8, < 0.001). New pacemaker rate (10.1 vs 1.3%, = 0.016) and the tendency toward neurologic events (8.9 vs 2.5%, = 0.086) were higher using RDV, induced mainly by the Perceval. Early mortality was equal (2.5 vs 1.3%, = 0.560). Revision for bleeding, dialysis, blood products, length-of-stay, gradients, and regurgitation was also equal. Risk analysis showed that low valve size, low ejection fraction, endocarditis, administration of red cells, and prolonged CPB time were predictors of elevated mortality.
Isolated bovine AVR has low mortality. Valves ≥ 23 mm show comparable gradients while the valve model matters < 23 mm. RDV should be used with care. Procedure-related times are shorter than those of CV but pacemaker implantation and neurologic events are more frequent (Perceval). Early mortality is low and valve performance comparable to CV.
传统带支架瓣膜（CV）仍是主动脉瓣疾病的金标准。牛心包人工瓣膜已得到改进，近十年来快速部署瓣膜（RDV）也已问世。我们比较了六种牛心包瓣膜的临床和血流动力学短期结果。
我们回顾性评估了连续829例接受牛主动脉瓣置换术（AVR）的患者（所有患者）。比较了来自不同制造商的四种CV（Mitroflow、Crown、Perimount、Trifecta）和两种RDV（Perceval、Intuity）在术前、术中和术后的数据。建立了死亡率风险模型。
所有瓣膜均降低了压力阶差。所有CV从23毫米起均显示出可接受的压力阶差。Mitroflow/Perceval为21毫米，Crown为19毫米，显示出高于平均水平的压力阶差。由于基线数据不同，我们在汇总的单独CV组和RDV组之间进行了倾向匹配。RDV的体外循环（CPB）、阻断和手术时间更短（87.4±34.0分钟对111.0±34.2分钟，54.3±21.1分钟对74.9±20.4分钟，155.2±42.9分钟对178.0±46.8分钟，<0.001）。使用RDV时新起搏器植入率（10.1%对1.3%，P = 0.016）和神经事件倾向（8.9%对2.5%，P = 0.086）更高，主要由Perceval引起。早期死亡率相当（2.5%对1.3%，P = 0.560）。因出血、透析、血液制品、住院时间、压力阶差和反流进行的翻修情况也相当。风险分析表明，瓣膜尺寸小、射血分数低、心内膜炎、红细胞输注以及CPB时间延长是死亡率升高的预测因素。
单纯牛心包AVR死亡率低。≥23毫米的瓣膜显示出相当的压力阶差，而<23毫米时瓣膜型号很重要。使用RDV应谨慎。与手术相关的时间比CV短，但起搏器植入和神经事件更频繁（Perceval）。早期死亡率低，瓣膜性能与CV相当。
