Stefanelli Guglielmo, Pirro Fabrizio, Macchione Andrea, Bellisario Alessandro, Weltert Luca
Department of Cardiac Surgery, Hesperia Hospital, Modena, Italy.
Department of Cardiac Surgery, European Hospital, Rome, Italy.
J Card Surg. 2020 May;35(5):988-995. doi: 10.1111/jocs.14510. Epub 2020 Mar 16.
To analyze the long-term results after Bentall operation using the stentless Shelhigh No-React (NR)-2000 bio-root prosthesis.
From 2004 to 2008, 26 consecutive, nonselected patients (mean age at surgery: 67 ± 9 years) underwent a Bentall operation using a stentless Shelhigh valved conduit at our institution. Mean preoperative Logistic-EuroSCORE was 17.1 ± 12.9. The mean size of the aortic root was 53.2 ± 5 mm. The mean preoperative ejection fraction was 55 ± 7.4%. Three patients had a bicuspid valve. One patient with acute endocarditis and one patient with type A aortic dissection were operated on an emergency. Three patients (11.54%) had a previous cardiac operation. The Button-Bentall technique was used in all cases. Seven patients (26.92%) received an associated procedure. The mean size of the implanted prosthesis was 26.1 ± 2.2. Follow-up ranged between 6 and 174 months (mean 93.4 ± 59.1 months). Primary endpoints consisted of early and late mortality, freedom from acute endocarditis, freedom from structural valve deterioration, and freedom from valve-related-reoperation.
Two patients died in hospital, while 10 patients died during follow-up time, of which three for cardiac causes (12.5%). Overall survival probability was 52.9% at 15 years. Freedom from acute endocarditis was 95.7% at 5 and 15 years. Freedom from severe aortic incompetence due to structural deterioration was 100% at 5 and 10 years, 90.9% at 15 years. The mean aortic gradient at follow-up was 11.4 ± 5 mm Hg. Freedom from valve-related reoperation was 100% at 5 and 10 years, 90.9% at 15 years.
In our experience, Bentall's operation using the Shelhigh NR-2000 stentless bio-conduit provided satisfactory early and long-term results. However, our findings are not consistent with unfavorable long-term outcomes following the implantation of this device reported by other authors.
分析使用无支架Shelhigh No-React（NR）-2000生物根部假体进行Bentall手术后的长期结果。
2004年至2008年，在我们机构，26例连续的、未经过挑选的患者（手术时平均年龄：67±9岁）使用无支架Shelhigh带瓣管道进行了Bentall手术。术前平均逻辑-欧洲心脏手术风险评估系统（Logistic-EuroSCORE）评分为17.1±12.9。主动脉根部平均大小为53.2±5mm。术前平均射血分数为55±7.4%。3例患者有二叶式瓣膜。1例急性心内膜炎患者和1例A型主动脉夹层患者接受了急诊手术。3例患者（11.54%）曾接受过心脏手术。所有病例均采用纽扣式Bentall技术。7例患者（26.92%）接受了相关手术。植入假体的平均大小为26.1±2.2。随访时间为6至174个月（平均93.4±59.1个月）。主要终点包括早期和晚期死亡率、无急性心内膜炎、无结构性瓣膜退变以及无瓣膜相关再次手术。
2例患者在住院期间死亡，10例患者在随访期间死亡，其中3例死于心脏原因（12.5%）。15年时总体生存概率为52.9%。5年和15年时无急性心内膜炎的概率为95.7%。5年和10年时因结构性退变导致的严重主动脉瓣关闭不全的发生率为0%，15年时为90.9%。随访时平均主动脉压差为11.4±5mmHg。5年和10年时无瓣膜相关再次手术的概率为100%，15年时为90.9%。
根据我们的经验，使用Shelhigh NR-2000无支架生物管道进行Bentall手术可提供令人满意的早期和长期结果。然而，我们的研究结果与其他作者报道的该装置植入后不良的长期结果不一致。
