Department of Surgery, Kurume University, Asahi-machi 67, Kurume-shi, Fukuoka, Japan.
Heart Vessels. 2021 Aug;36(8):1256-1263. doi: 10.1007/s00380-021-01802-5. Epub 2021 Feb 14.
Aortic stenosis (AS) is the most common valve disorder in advanced age. Previous reports have shown that low-flow status of the left ventricle is an independent predictor of cardiovascular mortality after surgery. The Trifecta bioprosthesis has recently shown favorable hemodynamic performance. This study aimed to evaluate the effect of the Trifecta bioprosthesis, which has a large effective orifice area, in patients with low-flow severe AS who have a poor prognosis. We retrospectively evaluated 94 consecutive patients with severe AS who underwent aortic valve replacement (AVR). Patients were divided into two groups according to the stroke volume index (SVI): low-flow (LF) group (SVI < 35 ml/m, n = 22) and normal-flow (NF) group (SVI ≥ 35 ml/m, n = 72). Patients' characteristics and early and mid-term results were compared between the two groups. There were no differences in patients' characteristics, except for systolic blood pressure (LF:NF = 120:138 mmHg, p < 0.01) and the rate of atrial fibrillation between the groups. A preoperative echocardiogram showed that the pressure gradient was higher in the NF group than in the LF group, but aortic valve area was similar. The Trifecta bioprosthesis size was similar in both groups. The operative outcomes were not different between the groups. Severe patient-prosthesis mismatch (PPM) (< 0.65 cm/m) was not observed in either of the groups. There were no significant differences in mid-term results between the two groups. The favorable hemodynamic performance of the Trifecta bioprosthesis appears to have the similar outcomes in the LF and NF groups. AVR with the Trifecta bioprosthesis should be considered for avoidance of PPM, particularly in AS patients with LV dysfunction.
主动脉瓣狭窄（AS）是老年人群中最常见的瓣膜疾病。先前的报告表明，左心室低流量状态是手术后心血管死亡率的独立预测因素。最近，Trifecta 生物瓣显示出良好的血流动力学性能。本研究旨在评估 Trifecta 生物瓣在预后不良的低流量严重 AS 患者中的效果。我们回顾性评估了 94 例接受主动脉瓣置换术（AVR）的严重 AS 连续患者。根据每搏输出量指数（SVI）将患者分为两组：低流量（LF）组（SVI<35 ml/m，n=22）和正常流量（NF）组（SVI≥35 ml/m，n=72）。比较两组患者的特征以及早期和中期结果。两组患者的特征除收缩压（LF：NF=120：138 mmHg，p<0.01）和心房颤动发生率外无差异。术前超声心动图显示 NF 组的压力梯度高于 LF 组，但主动脉瓣面积相似。两组的 Trifecta 生物瓣尺寸相似。两组的手术结果无差异。两组均未观察到严重的患者-人工瓣膜不匹配（PPM）（<0.65 cm/m）。两组的中期结果无显著差异。Trifecta 生物瓣良好的血流动力学性能在 LF 和 NF 组似乎具有相似的结果。AVR 采用 Trifecta 生物瓣应考虑避免 PPM，特别是在左心室功能障碍的 AS 患者中。
