Wong K, Shad S, Waterworth P D, Khaghani A, Pepper J R, Yacoub M H
Royal Brompton Hospital, London, England.
Ann Thorac Surg. 1995 Aug;60(2 Suppl):S402-5. doi: 10.1016/0003-4975(95)00265-m.
Stentless porcine valves in the aortic position offer many theoretic advantages, but their clinical performance has not been adequately defined. We evaluated the clinical and echocardiographic results of 103 patients who had aortic valve replacement with the Toronto stentless porcine valve over a 2-year period. There were 67 men with a mean age of 68 years. The predominant native valve lesion was aortic stenosis (64%), and 4 patients had prosthetic valve dysfunction. Forty-two patients had concomitant procedures. The 30-day mortality rate was 3.3% (n = 2) for isolated valve replacement and 5.8% (n = 6) for the series. The sole determinant of early death was poor left ventricular function. There were three late deaths due to non-valve-related complications over a median follow-up of 11.87 months. In addition, prosthetic valve endocarditis developed in 1 patient, necessitating a homograft valve replacement at 6 weeks. Doppler echocardiography performed at 3 to 6 months showed low peak and mean transvalvular gradients, with no substantial change at 1 year. None of the patients showed signs of clinically significant aortic regurgitation, although echocardiography demonstrated trivial or mild regurgitation in 12 patients at discharge or early follow-up, which was less marked or absent at 1 year. We conclude that the Toronto stentless porcine valve appears to offer promising early results.
主动脉位置的无支架猪瓣膜具有许多理论优势，但其临床性能尚未得到充分界定。我们评估了在两年期间接受多伦多无支架猪瓣膜主动脉瓣置换术的103例患者的临床和超声心动图结果。其中有67名男性，平均年龄为68岁。主要的原生瓣膜病变是主动脉瓣狭窄（64%），4例患者存在人工瓣膜功能障碍。42例患者同时进行了其他手术。单纯瓣膜置换术的30天死亡率为3.3%（n = 2），该系列患者的30天死亡率为5.8%（n = 6）。早期死亡的唯一决定因素是左心室功能差。在中位随访11.87个月期间，有3例因非瓣膜相关并发症导致的晚期死亡。此外，1例患者发生人工瓣膜心内膜炎，在6周时需要进行同种异体瓣膜置换。在3至6个月时进行的多普勒超声心动图显示跨瓣膜峰值和平均梯度较低，1年时无实质性变化。尽管超声心动图显示12例患者在出院时或早期随访时有轻微或轻度反流，但无患者出现具有临床意义的主动脉瓣反流迹象，1年时反流减轻或消失。我们得出结论，多伦多无支架猪瓣膜似乎能带来有希望的早期结果。
