David T E, Feindel C M, Bos J, Sun Z, Scully H E, Rakowski H
Division of Cardiovascular Surgery, Toronto Hospital, Ontario, Canada.
J Thorac Cardiovasc Surg. 1994 Dec;108(6):1030-6.
A stentless porcine aortic valve was used for aortic valve replacement in 123 patients from 1987 to 1993. The mean age of 86 men and 37 women was 61 +/- 12 years. Most patients had aortic stenosis; one-third had coronary artery disease and six had mitral valve disease. The stentless valve was secured in the subcoronary position by the same technique used for a freehand aortic valve homograft. The size of valve was based largely on the diameter of the sinotubular junction of the aortic root. The mean valve size was 26.5 mm (range 19 to 29 mm) and 87% were 25 mm or larger. Two operative deaths occurred, one the result of myocardial infarction and the other the result of infective endocarditis. Patients have been followed up from 3 to 77 months, mean 22 months. Three late deaths, none related to the valve, have occurred. The actuarial survival at 6 years was 91% +/- 4%. Four transient cerebral ischemic events have occurred, but two patients had extracranial cerebrovascular disease. One patient had endocarditis late in the postoperative period and required reoperation. All patients had Doppler echocardiographic studies before discharge from the hospital, 3 to 6 months later and annually. Only 15 patients have aortic insufficiency, trivial in 6 and mild in 9. The peak and mean systolic gradients decreased significantly during the first 3 to 6 months after implantation (p < 0.001), and the effective valve areas increased significantly during this time interval (p < 0.001). This improvement in valve hemodynamics is believed to be due to remodeling of the aortic root and regression of left ventricular hypertrophy. The results of aortic valve replacement with this stentless bioprosthesis have been excellent and justify its continued use in older patients.
1987年至1993年期间，123例患者接受了无支架猪主动脉瓣置换术。其中86例男性和37例女性的平均年龄为61±12岁。大多数患者患有主动脉瓣狭窄；三分之一患者患有冠状动脉疾病，6例患有二尖瓣疾病。采用与徒手主动脉瓣同种异体移植相同的技术将无支架瓣膜固定在冠状动脉下位置。瓣膜大小主要根据主动脉根部窦管交界处的直径确定。平均瓣膜大小为26.5mm（范围19至29mm），87%的瓣膜为25mm或更大。发生了2例手术死亡，1例死于心肌梗死，另1例死于感染性心内膜炎。对患者进行了3至77个月的随访，平均22个月。发生了3例晚期死亡，均与瓣膜无关。6年时的精算生存率为91%±4%。发生了4次短暂性脑缺血事件，但2例患者患有颅外脑血管疾病。1例患者在术后晚期发生心内膜炎，需要再次手术。所有患者在出院前、出院后3至6个月以及每年都进行了多普勒超声心动图检查。只有15例患者存在主动脉瓣关闭不全，其中6例为轻度，9例为轻度。植入后最初3至6个月内，峰值和平均收缩期梯度显著下降（p<0.001），在此时间间隔内有效瓣膜面积显著增加（p<0.001）。瓣膜血流动力学的这种改善被认为是由于主动脉根部重塑和左心室肥厚消退所致。使用这种无支架生物假体进行主动脉瓣置换的结果非常出色，证明其在老年患者中继续使用是合理的。
