三尖瓣主动脉瓣假体的失效模式。
Modes of failure of Trifecta aortic valve prosthesis.
机构信息
Wessex Cardiothoracic Centre, Department of Cardiac Surgery, University Hospital Southampton, Southampton, UK.
University of Southampton, Southampton, UK.
出版信息
Interact Cardiovasc Thorac Surg. 2022 Jul 9;35(2). doi: 10.1093/icvts/ivac086.
OBJECTIVES
Several concerns have been recently raised regarding the durability of Trifecta prostheses. Different mechanisms of early failure were reported. Our aim was to study in a large population the modes of failure of Trifecta valves.
METHODS
We conducted a retrospective analysis of patients who underwent surgical aortic valve replacement with a Trifecta prosthesis during the period 2010-2018. Details regarding the mode of failure and haemodynamic dysfunction were collected for patients who underwent reintervention for structural valve failure. The Kaplan-Meier method was used to calculate survival. Competing risk analysis was performed to calculate the cumulative risk of reintervention for structural valve failure.
RESULTS
The overall population comprises 1228 patients (1084 TF model and 144 TFGT model). Forty-four patients-mean patients' age at the time of the first implant 69 (standard deviation: 12) years and 61% female-underwent reintervention for structural valve failure after a median time of 63 [44-74] months. The cumulative incidence of reintervention for structural valve failure was 0.16% (SE 0.11%), 1.77% (SE 0.38%) and 5.11% (SE 0.98%) at 1, 5 and 9 years, respectively. In 24/44 patients (55%), a leaflet tear with dehiscence at the commissure level was found intraoperatively or described by imaging assessment. The cumulative incidence of reintervention for failure due to leaflet(s) tear was 0.16% (SE 0.11%), 1.08% (SE 0.29%) and 3.03% (SE 0.88%) at 1, 5 and 9 years, respectively.
CONCLUSIONS
Leaflet(s) tear with dehiscence along the stent post was the main mode of early failure, up to 5 years, after Trifecta valves' implantation.
目的
最近人们对 Trifecta 假体的耐用性提出了一些担忧。据报道，有不同的早期失效机制。我们的目的是在大样本人群中研究 Trifecta 瓣膜的失效模式。
方法
我们对 2010 年至 2018 年间接受 Trifecta 假体主动脉瓣置换术的患者进行了回顾性分析。对因结构性瓣膜失效而再次接受介入治疗的患者，收集了失效模式和血流动力学功能障碍的详细信息。采用 Kaplan-Meier 法计算生存率。采用竞争风险分析计算结构性瓣膜失效再次介入治疗的累积风险。
结果
总人群包括 1228 例患者（1084 例 TF 模型和 144 例 TFGT 模型）。44 例患者-首次植入时的平均年龄为 69（标准差：12）岁，61%为女性-在中位时间 63[44-74]个月后因结构性瓣膜失效而再次接受介入治疗。结构性瓣膜失效再次介入治疗的累积发生率分别为 0.16%（SE 0.11%）、1.77%（SE 0.38%）和 5.11%（SE 0.98%），分别在 1、5 和 9 年时。在 44 例患者中的 24 例（55%）中，术中发现或影像学评估显示瓣叶撕裂伴有交界分离。瓣叶撕裂导致的失效再次介入治疗的累积发生率分别为 0.16%（SE 0.11%）、1.08%（SE 0.29%）和 3.03%（SE 0.88%），分别在 1、5 和 9 年时。
结论
在 Trifecta 瓣膜植入后 5 年内，瓣叶撕裂伴支架后撕裂是早期失效的主要模式。
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