避免瓣环缝合过大可导致跨瓣压差降低，术后永久性起搏器植入减少。
Avoiding oversizing in sutureless valves leads to lower transvalvular gradients and less permanent pacemaker implants postoperatively.
机构信息
Department of Cardiovascular Sciences-Cardiac Surgery, Katholieke Universiteit Leuven, Leuven, Belgium.
Department of Cardiovascular Surgery, CHU de Liège, Liège, Belgium.
出版信息
Interact Cardiovasc Thorac Surg. 2022 Jul 9;35(2). doi: 10.1093/icvts/ivac157.
OBJECTIVES
The aim of this study was to evaluate the impact of changing the sizing strategy in aortic valve replacement using the Perceval sutureless prosthesis on haemodynamic outcomes and postoperative pacemaker implantation.
METHODS
Retrospective analysis of patients implanted with the Perceval valve between 2007 and 2019 was performed by comparing patients implanted before the modification of sizing strategy (OLD group) and after (NEW group). The outcome parameters evaluated were the implanted prosthesis size, haemodynamical profile and postoperative pacemaker implantation.
RESULTS
The entire patient cohort (784 patients) consisted of 52% female patients, with a mean age of 78.53 [standard deviation (SD): 5.8] years and a mean EuroSCORE II of 6.3 (range 0.7-76). In 55.5% of cases, surgery was combined. The NEW cohort had more male patients (54.6% vs 43.4%) (P = 0.002). Mean implanted valve size, corrected for body surface area, was significantly lower in the NEW cohort (13.1, SD: 1.4 vs 13.5, SD: 1.4 mm/m2, P < 0.001). The 30-day mortality was 3.4%. Peak and mean transvalvular gradients at discharge were significantly lower in the NEW versus OLD groups: 24.4 mmHg (SD: 9.2) versus 28.4 mmHg (SD: 10.3) (P < 0.001) and 13.6 mmHg (SD: 5.3) versus 15.5 mmHg (SD: 6.0) (P < 0.001). The mean effective opening area and the indexed effective opening area, respectively, increased from 1.5 cm2 (SD: 0.5) and 0.85 cm2/m2 (SD: 0.27) in the OLD group to 1.7 cm2 (SD: 0.5) and 0.93 cm2/m2 (SD: 0.30) in the NEW group (P < 0.001). No difference was found in paravalvular leakage ≥1/4. Centrovalvular leakage ≥1/4 significantly decreased from 18% to 7.9% (P < 0.001). With the new sizing, the new postoperative pacemaker implantation rate decreased significantly from 11% to 6.1% (P = 0.016).
CONCLUSIONS
Correct sizing of sutureless aortic valves is crucial to obtain the best possible haemodynamics and avoid complications.
目的
本研究旨在评估使用 Perceval 无缝线假体更换主动脉瓣时改变尺寸策略对血流动力学结果和术后起搏器植入的影响。
方法
通过比较 2007 年至 2019 年期间植入 Perceval 瓣膜的患者（OLD 组）和植入后（NEW 组）的患者，对植入 Perceval 瓣膜的患者进行回顾性分析。评估的结果参数包括植入假体大小、血流动力学特征和术后起搏器植入。
结果
整个患者队列（784 例患者）中 52%为女性患者，平均年龄为 78.53 [标准差（SD）：5.8]岁，平均 EuroSCORE II 为 6.3（范围 0.7-76）。55.5%的病例为联合手术。NEW 队列中男性患者比例更高（54.6% vs 43.4%）（P = 0.002）。NEW 队列中植入的瓣膜尺寸校正后的平均面积明显较小（13.1，SD：1.4 毫米/米 2 vs 13.5，SD：1.4 毫米/米 2 ）（P < 0.001）。30 天死亡率为 3.4%。NEW 组与 OLD 组出院时的峰值和平均跨瓣梯度明显较低：24.4 mmHg（SD：9.2）与 28.4 mmHg（SD：10.3）（P < 0.001）和 13.6 mmHg（SD：5.3）与 15.5 mmHg（SD：6.0）（P < 0.001）。有效开口面积和指数有效开口面积分别从 OLD 组的 1.5 cm2（SD：0.5）和 0.85 cm2/m2（SD：0.27）增加到 NEW 组的 1.7 cm2（SD：0.5）和 0.93 cm2/m2（SD：0.30）（P < 0.001）。发现无瓣周漏≥1/4 没有差异。瓣周漏≥1/4 从 18%显著下降到 7.9%（P < 0.001）。使用新的尺寸，新的术后起搏器植入率从 11%显著下降到 6.1%（P = 0.016）。
结论
正确的无缝线主动脉瓣尺寸是获得最佳血流动力学和避免并发症的关键。
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