Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.
Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
Ann Thorac Surg. 2020 Nov;110(5):1549-1556. doi: 10.1016/j.athoracsur.2020.02.030. Epub 2020 Mar 21.
Aortic valve replacement in patients with a small aortic root is a matter of concern in terms of prosthesis-patient mismatch. We evaluated the survival and hemodynamic performance after implantation of a small rapid-deployment aortic valve (EDWARDS INTUITY valve system sizes 19 and 21 mm).
Between May 2010 and November 2018, 659 consecutive patients with severe aortic stenosis who received a rapid-deployment valve were included in a prospective and ongoing database. A small aortic bioprosthesis (sizes 19 mm and 21 mm) was implanted in 217 (32.9%) patients (mean age 74.9 ± 7.9 years, 85.3% women). Preoperative characteristics, operative parameters, and postoperative outcomes were assessed.
Mean gradients at discharge and 1 year were 14.8 ± 5.6 mm Hg and 13.6 ± 4.9 mm Hg, respectively. Mean effective orifice area and the indexed effective orifice area at discharge were 1.55 ± 0.36 cm and 0.87 ± 0.22 cm/m, respectively, and prosthesis-patient mismatch occurred in 77 (35.5%) patients (25.8% moderate and 9.7% severe). Perioperative mortality was 1.8% (n = 4 of 217) and overall survival at 1 year and 5 years was 91% and 79%, respectively. The presence of any prosthesis-patient mismatch degree did not have a significant influence on overall survival (hazard ratio, 0.95; 95% confidence interval, 0.75-1.19; P = .638). At the last follow-up, mean New York Heart Association functional class was 1.5 ± 0.7 vs 2.8 ± 0.6 at baseline (P < .001).
Surgical aortic valve replacement with rapid-deployment valves has shown improved results concerning hemodynamic performance, with decreased rates of prosthesis-patient mismatch. We observed excellent early-term and midterm survival and a significant improvement in functional class in this subgroup of patients with a small annulus.
在主动脉瓣置换术中，对于主动脉瓣环较小的患者，人工瓣膜与患者不匹配是一个值得关注的问题。我们评估了植入小尺寸快速部署主动脉瓣（EDWARDS INTUITY 瓣膜系统 19 号和 21 号）后的患者生存率和血流动力学性能。
2010 年 5 月至 2018 年 11 月，连续纳入 659 例接受快速部署瓣膜的严重主动脉瓣狭窄患者，纳入前瞻性和持续进行的数据库。217 例（32.9%）患者植入小尺寸生物瓣（19 毫米和 21 毫米）（平均年龄 74.9±7.9 岁，85.3%为女性）。评估术前特征、手术参数和术后结果。
出院时和 1 年时的平均跨瓣梯度分别为 14.8±5.6mmHg 和 13.6±4.9mmHg。出院时的平均有效瓣口面积和指数有效瓣口面积分别为 1.55±0.36cm 和 0.87±0.22cm/m，25.8%的患者为中度不匹配，9.7%的患者为重度不匹配，共有 77 例（35.5%）患者出现人工瓣膜与患者不匹配。围手术期死亡率为 1.8%（n=4 of 217），1 年和 5 年的总生存率分别为 91%和 79%。任何程度的人工瓣膜与患者不匹配均对总生存率无显著影响（风险比，0.95；95%置信区间，0.75-1.19；P=0.638）。最后一次随访时，平均纽约心脏协会心功能分级从基线时的 2.8±0.6 降至 1.5±0.7（P<0.001）。
快速部署瓣膜的主动脉瓣置换术在血流动力学性能方面显示出改善的结果，人工瓣膜与患者不匹配的发生率降低。在这个小瓣环患者亚组中，我们观察到早期和中期生存率优异，心功能分级显著改善。
