Kueri Sami, Berger Tim, Puiu Paul-Cătălin, Alhamami Yasir, Diab Nawras, Czerny Martin, Hochholzer Willibald, Siepe Matthias
Department of Cardiovascular Surgery, University Heart Center Freiburg Bad Krozingen, Bad Krozingen, Baden-Württemberg, Germany.
Departement of Vascular Surgery, University Hospital Zurich, Zurich, Switzerland.
Thorac Cardiovasc Surg. 2023 Oct;71(7):542-549. doi: 10.1055/s-0042-1755207. Epub 2022 Aug 20.
The Perceval valve was shown to facilitate minimal-invasive operations and shorten operative times. We aimed to compare the early results of the Perceval valve to those of well-established valves, namely the Carpentier-Edwards Perimount and Perimount Magna Ease valve protheses, in terms of their clinical and hemodynamic performances.
This is a single-center, retrospective, observational cohort study. For every patient operated with a Perceval valve, the last patient before and the next following patient receiving a Perimount valve was included in a control group leading to a 2:1 ratio (Perimount:Perceval). A propensity score matching was used and a subgroup analysis was performed to compare early and late Perceval patients as the sizing technique was changed over time.
From November 2013 to November 2017, 423 patients were identified. These included 141 consecutive patients receiving a Perceval valve through a full- or a hemi-sternotomy. In addition, 282 patients receiving a Perimount or a Magna Ease valve were enrolled. After propensity score matching, 127 matched patients were compared. Operating times were shorter and postoperative transvalvular pressure gradients were lower in the Perceval group (15 vs. 17 mmHg, = 0.002). There was no difference in mortality and stroke rates. The incidence of new pacemaker implantations was higher in the Perceval group (7.1 vs. 18.9%, = 0.005), mainly due to a very high incidence in the early phase of our Perceval experience prior to a change in the Perceval implantation technique. Subgroup analysis showed significantly better results in the late Perceval group.
Surgical outcome was good in both groups. The Perceval valve exhibited lower postoperative gradients, and the need for pacemaker implantation was higher and can be reduced by avoiding oversizing.
已证明Perceval瓣膜有助于微创操作并缩短手术时间。我们旨在比较Perceval瓣膜与成熟瓣膜（即Carpentier-Edwards Perimount和Perimount Magna Ease瓣膜假体）在临床和血流动力学性能方面的早期结果。
这是一项单中心、回顾性、观察性队列研究。对于每一位接受Perceval瓣膜手术的患者，将其之前最后一位和之后紧接着接受Perimount瓣膜的患者纳入对照组，形成2:1的比例（Perimount:Perceval）。采用倾向得分匹配法，并进行亚组分析以比较早期和晚期接受Perceval瓣膜的患者，因为随着时间推移，尺寸测量技术发生了变化。
2013年11月至2017年11月期间，共确定了423例患者。其中包括141例通过全胸骨切开术或半胸骨切开术接受Perceval瓣膜的连续患者。此外，还纳入了282例接受Perimount或Magna Ease瓣膜的患者。经过倾向得分匹配后，对127例匹配患者进行了比较。Perceval组的手术时间更短，术后跨瓣膜压力梯度更低（15 vs. 17 mmHg，P = 0.002）。死亡率和中风发生率无差异。Perceval组新起搏器植入的发生率更高（7.1% vs. 18.9%，P = 0.005），主要是因为在我们使用Perceval瓣膜经验的早期阶段，在Perceval植入技术改变之前发生率非常高。亚组分析显示晚期Perceval组的结果明显更好。
两组的手术结果均良好。Perceval瓣膜术后梯度较低，起搏器植入需求较高，通过避免尺寸过大可降低该需求。
