Concistrè Giovanni, Bianchi Giacomo, Chiaramonti Francesca, Margaryan Rafik, Marchi Federica, Kallushi Enkel, Solinas Marco
Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy.
Innovations (Phila). 2019 Oct;14(5):445-452. doi: 10.1177/1556984519872990. Epub 2019 Sep 2.
Patients with severe aortic stenosis and reduced left ventricular ejection fraction (LVEF) have a poor prognosis compared with patients with preserved LVEF. To evaluate the impact of sutureless Perceval (LivaNova, Italy) aortic bioprosthesis on LVEF and clinical outcomes in patients with baseline left ventricular (LV) dysfunction who underwent isolated aortic valve replacement (AVR).
Between March 2011 and August 2017, 803 patients underwent AVR with Perceval bioprosthesis implantation. Fifty-two isolated AVR had preoperative LVEF ≤45%. Mean age of these patients was 77 ± 6 years, 24 patients were female (46%), and mean EuroSCORE II was 9.4% ± 4.8%. Perceval bioprosthesis was implanted in 9 REDO operations. In 43 patients (83%), AVR was performed in minimally invasive surgery with an upper ministernotomy ( = 13) or right anterior minithoracotomy ( = 30).
One patient died in hospital. Cardiopulmonary bypass and aortic cross-clamp times were 85.5 ± 26 minutes and 55.5 ± 19 minutes, respectively. At mean follow-up of 33 ± 20 months (range: 1 to 75 months), survival was 90%, freedom from reoperation was 100%, and mean transvalvular pressure gradient was 11 ± 5 mmHg. LVEF improved from 37% ± 7% preoperatively to 43% ± 8% at discharge ( < 0.01) and further increased to 47% ± 9% at follow-up ( = 0.06), LV mass decreased from 149.8 ± 16.9 g/m preoperatively to 115.3 ± 11.6 g/m at follow-up ( < 0.001), and moderate paravalvular leakage occurred in 1 patient without hemolysis not requiring any treatment.
AVR with sutureless aortic bioprosthesis implantation in patients with preoperative LV dysfunction demonstrated a significant immediate and early improvement in LVEF.
与左心室射血分数（LVEF）保留的患者相比，重度主动脉瓣狭窄且LVEF降低的患者预后较差。评估无缝合Perceval（意大利索林集团）主动脉生物瓣膜对接受单纯主动脉瓣置换术（AVR）的基线左心室（LV）功能障碍患者的LVEF及临床结局的影响。
2011年3月至2017年8月期间，803例患者接受了Perceval生物瓣膜植入的AVR手术。52例单纯AVR患者术前LVEF≤45%。这些患者的平均年龄为77±6岁，24例为女性（46%），平均欧洲心脏手术风险评估系统（EuroSCORE）II评分为9.4%±4.8%。Perceval生物瓣膜在9例再次手术中植入。43例患者（83%）通过微创上半胸骨切开术（n = 13）或右前小切口开胸术（n = 30）进行AVR。
1例患者住院期间死亡。体外循环时间和主动脉阻断时间分别为85.5±26分钟和55.5±19分钟。平均随访33±20个月（范围：1至75个月）时，生存率为90%，再次手术率为100%，平均跨瓣压差为11±5 mmHg。LVEF从术前的37%±7%改善至出院时的43%±8%（P<0.01），随访时进一步升至47%±9%（P = 0.06），左心室质量从术前的149.8±16.9 g/m降至随访时的115.3±11.6 g/m（P<0.001），1例患者出现中度瓣周漏且无溶血，无需任何治疗。
术前LV功能障碍患者植入无缝合主动脉生物瓣膜进行AVR，可使LVEF立即且早期得到显著改善。
