Karic Alen, Busevac Ervin, Krajnovic Alma, Mujaric Ekrema
Clinic for Cardiovascular Surgery, Clinical Centre University of Sarajevo, Bosnia and Herzegovina.
Cantonal Hospital Zenica, Bosnia and Herzegovina.
Acta Inform Med. 2025;33(2):123-128. doi: 10.5455/aim.2025.33.123-128.
Aortic stenosis (AS) is the most common form of valvular disease in the elderly population, with degenerative calcified valves remaining the primary cause of this condition. Due to the progressive nature of the disease, a significant reduction in aortic valve area leads to increased left ventricular (LV) pressure overload, resulting in adaptive but ultimately maladaptive concentric hypertrophy and progressive myocardial remodeling.
The main objectives of the study were to assess the regression of left ventricular (LV) hypertrophy.
This retrospective study included 150 patients who underwent surgical aortic valve replacement (AVR) with the Sorin Freedom Solo (SFS) stentless bioprosthesis and the St. Jude Regent (STJ) mechanical valve. Patients were divided into three groups based on follow-up duration: six months, one year, and two years. changes in transvalvular gradient, perioperative outcomes, and survival rates.
The results showed a significant reduction in the transvalvular gradient for both valves (p < 0.0001), with a more pronounced decrease in patients with the SFS valve. The thickness of the interventricular septum (IVS) continuously decreased in SFS patients across all groups, whereas a significant reduction was observed only in Group 2 for STJ valves. Left ventricular ejection fraction (LVEF) showed a significantly greater increase in patients with the SFS valve (p < 0.024), particularly in Group 2. Overall mortality was 5.30% for STJ valves and 6.66% for SFS valves, with no statistically significant differences in Kaplan-Meier survival analysis (p > 0.05).
The SFS valve demonstrated superior hemodynamic performance and more pronounced LV hypertrophy regression, making it a suitable option for high-risk patients. The STJ valve ensures stable long-term function and remains the preferred choice for younger patients with acceptable operative risk. These findings highlight the importance of a personalized approach in selecting valvular prostheses.
主动脉瓣狭窄（AS）是老年人群中最常见的瓣膜疾病形式，退行性钙化瓣膜仍是该病的主要病因。由于疾病的进展性质，主动脉瓣面积显著减小会导致左心室（LV）压力超负荷增加，从而导致适应性但最终失代偿的向心性肥厚和进行性心肌重塑。
本研究的主要目的是评估左心室（LV）肥厚的消退情况。
这项回顾性研究纳入了150例行手术主动脉瓣置换（AVR）的患者，他们分别使用了索林自由独奏（SFS）无支架生物瓣膜和圣犹达Regent（STJ）机械瓣膜。根据随访时间将患者分为三组：六个月、一年和两年。评估跨瓣压差、围手术期结果和生存率的变化。
结果显示，两种瓣膜的跨瓣压差均显著降低（p < 0.0001），SFS瓣膜患者的降低更为明显。在所有组中，SFS患者的室间隔（IVS）厚度持续下降，而STJ瓣膜仅在第2组中观察到显著降低。左心室射血分数（LVEF）在SFS瓣膜患者中显著增加（p < 0.024），特别是在第2组。STJ瓣膜的总死亡率为5.30%，SFS瓣膜为6.66%，在Kaplan-Meier生存分析中无统计学显著差异（p > 0.05）。
SFS瓣膜表现出卓越的血流动力学性能和更明显的LV肥厚消退，使其成为高危患者的合适选择。STJ瓣膜确保长期功能稳定，仍然是手术风险可接受的年轻患者的首选。这些发现凸显了个性化方法在选择瓣膜假体中的重要性。
