Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Department of Medical Informatics, Center for Information, Jichi Medical University, Tochigi, Japan.
Eur J Cardiothorac Surg. 2022 Feb 18;61(3):625-634. doi: 10.1093/ejcts/ezab379.
Transcatheter aortic valve replacement is known to be associated with improved haemodynamics in patients with aortic stenosis and a small aortic annulus. However, limited benchmark data are available regarding the long-term outcomes in patients treated with surgical aortic valve replacement (SAVR). We investigated the long-term outcomes of SAVR using a 19-mm bioprosthesis.
This study included consecutive patients who underwent SAVR using a 19-mm bioprosthesis at our hospital between 2008 and 2012.
In a total of 132 patients, moderate and severe prosthesis-patient mismatch occurred in 36 (27.3%) and 7 patients (5.3%), respectively. The median follow-up period was 7.7 years. The overall 5- and 10-year survival rates were 79.4% and 52.9%, respectively. The 5- and 10-year freedom from major adverse valve-related events rates were 89.6% and 74.2%, respectively. Neither moderate nor severe prosthesis-patient mismatch was associated with late mortality, major adverse valve-related events or heart failure. Follow-up echocardiographic data were obtained at a median interval of 4.8 years in 80% of patients who survived ≥6 months postoperatively. Follow-up echocardiographic data showed a significantly increased left ventricular ejection fraction, decreased mean transvalvular/transprosthetic pressure gradients and a decreased mean left ventricular mass. At follow-up, we observed moderate or severe haemodynamic structural valve deterioration in 17 patients; however, structural valve deterioration did not affect late survival or freedom from major adverse valve-related events rates, or heart failure.
SAVR using the 19-mm bioprosthesis was associated with satisfactory long-term clinical and haemodynamic outcomes.
经导管主动脉瓣置换术已知可改善主动脉瓣狭窄伴小主动脉瓣环患者的血液动力学。然而，关于接受外科主动脉瓣置换术（SAVR）治疗的患者的长期结果，可用的基准数据有限。我们研究了使用 19 毫米生物瓣进行 SAVR 的长期结果。
这项研究包括 2008 年至 2012 年期间在我院接受 19 毫米生物瓣 SAVR 的连续患者。
在总共 132 名患者中，分别有 36 名（27.3%）和 7 名（5.3%）患者出现中度和重度假体-患者不匹配。中位随访时间为 7.7 年。总体 5 年和 10 年生存率分别为 79.4%和 52.9%。5 年和 10 年免于重大不良瓣膜相关事件的发生率分别为 89.6%和 74.2%。中度或重度假体-患者不匹配均与晚期死亡率、重大不良瓣膜相关事件或心力衰竭无关。在 80%的术后存活≥6 个月的患者中，以中位数间隔 4.8 年获得了随访超声心动图数据。随访超声心动图数据显示左心室射血分数显著增加，平均跨瓣/跨瓣压力梯度降低，平均左心室质量降低。在随访中，我们观察到 17 名患者出现中度或重度血流动力学结构性瓣膜恶化；然而，结构性瓣膜恶化并不影响晚期生存率或免于重大不良瓣膜相关事件的发生率，也不影响心力衰竭。
使用 19 毫米生物瓣的 SAVR 与令人满意的长期临床和血液动力学结果相关。
