Carrel Thierry, Heinisch Paul Philipp
Department for Cardiovascular Surgery, University Hospital and University of Bern, Bern, Switzerland.
Ann Cardiothorac Surg. 2020 Sep;9(5):375-385. doi: 10.21037/acs-2020-surd-18.
Degenerative aortic stenosis is the most frequent valvular heart disease in industrialized countries. Conservative treatment may beneficially influence symptoms but is never successful. Surgical aortic valve replacement (SAVR) was the only recognized treatment option to provide substantially prolonged survival until 2008. Operative mortality of isolated SAVR has been reported as low as 0.5% to 1% in experienced institutions, while long-term survival is close to that observed in a control healthy population of similar age. A multitude of studies have demonstrated the beneficial effects of SAVR with regard to improvement in quality of life and physical performance in the majority of symptomatic patients. In the last decade, transcatheter aortic valve implantation (TAVI) has emerged as an equal treatment modality, first in patients with high surgical risk and more recently in patients with intermediate and low surgical risk. Paravalvular regurgitation and the higher rate of pacemaker implantation remain points of consideration. Additionally, the long-term durability of TAVI devices and occurrence of stroke late after TAVI require additional analyses. Sutureless (SU-SAVR) and rapid deployment valve (R-SAVR) were designed to simplify and accelerate a conventional or less invasive surgical procedure while allowing complete excision of the calcified native valve. From 3 different implants tested more than 10 to 15 years ago, only two are available on the market today: the Perceval valve from Liva Nova and the Intuity sutureless prosthesis from Edwards Lifesciences. There has been extensive experience with these two devices in previous years and the results obtained are comparable to those observed following the use of conventional implants. The sutureless devices may be of particular interest for more complex and combined surgical procedures. This review summarizes the sutureless (SU-SAVR) and rapid deployment valve technologies and presents a clinical outlook for the patient population managed with these devices.
退行性主动脉瓣狭窄是工业化国家最常见的心脏瓣膜疾病。保守治疗可能对症状有有益影响，但从未成功。直到2008年，外科主动脉瓣置换术（SAVR）是唯一被认可的能显著延长生存期的治疗选择。在经验丰富的机构中，单纯SAVR的手术死亡率据报道低至0.5%至1%，而长期生存率接近年龄相仿的健康对照人群。大量研究表明，SAVR对大多数有症状患者的生活质量和身体机能改善有有益作用。在过去十年中，经导管主动脉瓣植入术（TAVI）已成为一种同等的治疗方式，最初用于手术风险高的患者，最近也用于手术风险中等和低的患者。瓣周反流和较高的起搏器植入率仍是需要考虑的问题。此外，TAVI装置的长期耐用性以及TAVI术后晚期中风的发生需要进一步分析。无缝合（SU-SAVR）和快速植入瓣膜（R-SAVR）旨在简化和加速传统或微创外科手术，同时允许完全切除钙化的天然瓣膜。10到15年前测试的3种不同植入物中，如今市场上仅剩下两种：Liva Nova公司的Perceval瓣膜和Edwards Lifesciences公司的Intuity无缝合假体。过去几年对这两种装置有广泛的经验，所获结果与使用传统植入物后观察到的结果相当。无缝合装置对于更复杂的联合外科手术可能特别有意义。本综述总结了无缝合（SU-SAVR）和快速植入瓣膜技术，并对使用这些装置治疗的患者群体给出临床展望。
