Ezelsoy Mehmet, Oral Kerem, Saracoglu Kemal Tolga, Saracoglu Ayten, Bayramoglu Zehra, Akpinar Belhhan
Department of Cardiovascular Surgery, Istanbul Bilim University, Istanbul, Turkey.
Department of Anesthesiology and Reanimation, Health Sciences University, Istanbul, Turkey.
Heart Surg Forum. 2020 Feb 10;23(1):E034-E038. doi: 10.1532/hsf.2661.
The study is presenting our long-term clinical results after freestyle stentless aortic root bioprosthesis replacement in patients with severe aortic insufficiency with ascending aortic aneurysm.
Seventy-seven patients with ascending aortic aneurysms and aortic valve insufficiency underwent a total root replacement procedure using a stentless "Freestyle" valve (Medtronic Inc., Minneapolis, Minnesota). There were 50 (64.9%) men and 27 (35.1%) women. Mean age was 68.7 ± 11.1 years. The surgical procedure used a complete root replacement. Concomitant procedures included coronary artery bypass grafting in 15 (19.5%) patients.
The mean cardiopulmonary bypass time was 130.3 ± 26.4 minutes and total aortic cross clamp time was 99.5 ± 23.6 minutes. Hospital mortality was 2.6%. The median follow-up time was 11.2 years. The 5- and 10-years freedom from aortic valve reoperation were 97.4 ± 1.2% and 93.4 ± 4.9%, respectively. During 10 years follow up, there were 14 late deaths; 4 deaths were cardiac, and 10 deaths were noncardiac. Valve-related deaths were attributable to thromboembolism in 1 patient, endocarditis in 2 patients, and congestive heart failure in 1 patient.
The freestyle stentless aortic root bioprosthesis offered good clinical outcomes, in terms of survival and structural valve deterioration. The Freestyle valve is a viable option for use in patients undergoing bioprosthetic aortic valve replacement and expected desire for long-term durability.
本研究展示了在患有升主动脉瘤且严重主动脉瓣关闭不全的患者中，使用无支架主动脉根部生物瓣膜置换术后的长期临床结果。
77例患有升主动脉瘤和主动脉瓣关闭不全的患者接受了使用无支架“Freestyle”瓣膜（美敦力公司，明尼阿波利斯，明尼苏达州）的全根部置换手术。其中男性50例（64.9%），女性27例（35.1%）。平均年龄为68.7±11.1岁。手术采用完全根部置换。同期手术包括15例（19.5%）患者进行冠状动脉搭桥术。
平均体外循环时间为130.3±26.4分钟，总主动脉阻断时间为99.5±23.6分钟。医院死亡率为2.6%。中位随访时间为11.2年。主动脉瓣再次手术的5年和10年无事件生存率分别为97.4±1.2%和93.4±4.9%。在10年的随访期间，有14例晚期死亡；4例死于心脏原因，10例死于非心脏原因。瓣膜相关死亡原因包括1例血栓栓塞、2例心内膜炎和1例充血性心力衰竭。
就生存率和瓣膜结构恶化而言，无支架主动脉根部生物瓣膜提供了良好的临床结果。Freestyle瓣膜是用于接受生物人工主动脉瓣置换且期望长期耐用性的患者的可行选择。
