与传统人工瓣膜相比，采用微创胸骨切开术及无缝合人工瓣膜植入的主动脉瓣置换手术中的体外循环和主动脉阻断时间：一项横断面研究
Cardiopulmonary Bypass and Cross-Clamping Times in Aortic Valve Replacement Surgery by Ministernotomy with Sutureless Prosthesis Implantation Compared to Conventional Prosthesis: A Cross-Sectional Study.
作者信息
Perazzo Álvaro, Mariani Silvia, Montenegro Gabriela Lucena, Conci Luca, Sepúlveda Diana Patrícia Lamprea, Steffen Samuel Padovani, Gaiotto Fabio Antonio, Lorusso Roberto, Caldas Silvio, Lins Esdras Marques, Leal João Carlos Ferreira, Moraes Fernando Ribeiro de
机构信息
Department of Surgery, Postgraduate Program in Surgery, Centro de Ciências Médicas, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil.
Transplant Center, Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, São Paulo, Brazil.
出版信息
Braz J Cardiovasc Surg. 2025 Mar 18;40(2):e20240290. doi: 10.21470/1678-9741-2024-0290.
INTRODUCTION
Valve replacement is one of the effective treatments for aortic valve disease. This study aims to compare cardiopulmonary bypass and ischemia times in aortic valve replacement surgeries using stented biological and sutureless prostheses (PERCEVAL®) through a minimally invasive ministernotomy approach. Methods: This single-center cross-sectional study, conducted from February 2015 to February 2021, assessed clinical and epidemiological characteristics in aortic valve replacement patients. It analyzed factors including hospital stay, early outcomes, valve etiology, intraoperative diagnosis, systolic gradients, left ventricular ejection fraction, and left ventricular mass. Two groups were studied: 12 patients with PERCEVAL® prostheses and 81 with conventional bioprostheses.
RESULTS
This study included 93 patients (age: 59 ± 16 years), 61.3% were male, and 80.2% had hypertension; dyslipidemias were present in 34.1% and 25.3% were diabetic. Cardiopulmonary bypass and cross-clamping times were 61 minutes and 41 minutes in the conventional bioprostheses group and 59.5 minutes and 39.5 minutes in the PERCEVAL® group (P=0.143 and P=0.058, respectively). Intensive care unit and overall hospital stays were statistically comparable between both groups (P=0.662 and P=0.599, respectively). All participants survived the 30-day postoperative period, with minimal complications, no significant differences in echocardiographic parameters were observed, yet higher values for certain cardiac function indicators were noted in the conventional bioprostheses group.
CONCLUSION
The groups with conventional bioprostheses and sutureless prostheses (PERCEVAL®) didn't display significant differences in the analyzed variables for ministernotomy aortic valve replacement surgery. They exhibited similar results in terms of hospital stay duration, 30-day outcomes, and cardiac function values.
引言
瓣膜置换术是治疗主动脉瓣疾病的有效方法之一。本研究旨在通过微创胸骨上段小切口入路，比较使用带支架生物瓣膜和无缝合人工瓣膜（PERCEVAL®）进行主动脉瓣置换手术时的体外循环时间和缺血时间。方法：本单中心横断面研究于2015年2月至2021年2月进行，评估主动脉瓣置换患者的临床和流行病学特征。分析了包括住院时间、早期结局、瓣膜病因、术中诊断、收缩期梯度、左心室射血分数和左心室质量等因素。研究了两组：12例使用PERCEVAL®人工瓣膜的患者和81例使用传统生物瓣膜的患者。
结果
本研究纳入93例患者（年龄：59±16岁），61.3%为男性，80.2%患有高血压；34.1%存在血脂异常，25.3%为糖尿病患者。传统生物瓣膜组的体外循环时间和主动脉阻断时间分别为61分钟和41分钟，PERCEVAL®组分别为59.5分钟和39.5分钟（分别为P=0.143和P=0.058）。两组的重症监护病房住院时间和总住院时间在统计学上具有可比性（分别为P=0.662和P=0.599）。所有参与者术后30天均存活，并发症极少，超声心动图参数未观察到显著差异，但传统生物瓣膜组某些心功能指标的值较高。
结论
在分析的胸骨上段小切口主动脉瓣置换手术变量中，传统生物瓣膜组和无缝合人工瓣膜（PERCEVAL®）组未显示出显著差异。在住院时间、30天结局和心功能值方面，它们表现出相似的结果。
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