Mullany C J, Schaff H V, Orszulak T A, Miller F A
Division of Thoracic and Cardiovascular Surgery, Mayo Clinic and Foundation, Rochester, Minnesota.
J Heart Valve Dis. 1994 Nov;3(6):641-7.
Between October 1990 and June 1992, 89 patients underwent aortic valve replacement using the Intact porcine bioprosthesis. Their mean age (+/- SD) was 74.6 +/- 7.8 years (range 48 to 92). Seventy-five percent were in NYHA Class III-IV, 79 (89%) had AS or AS/AI, 10 (11%) had had previous cardiac surgery and 25 (32%) had an EF < 0.50. Associated procedures included CABG 45 (51%), septal myectomy 13 (15%), annular enlargement eight (9%), LV aneurysmectomy one, ascending aortic replacement one, and arch replacement one. Hospital mortality was four (4.5%). Hemodynamics were assessed with 2D echo with Doppler at seven days, six weeks and 12 months, and compared with 130 standard Carpentier-Edwards (C-E) porcine bioprostheses. At follow up, two patients have 2/4 perivalvular AI. The transvalvular gradients for the Intact valve were as follows: 21 mm-16.9 +/- 7.4 mmHg; 23 mm-18.9 +/- 6.2 mmHg; 25 mm-17.1 +/- 5.4 mmHg; 27 mm-15.0 +/- 3.7 mmHg; and 29 mm-15.0 +/- 2.1 mmHg. When compared to the standard Carpentier-Edwards porcine bioprostheses, the 21 mm Intact valve had the same gradient as the C-E prosthesis. However, the transvalvular gradients were slightly higher for the Intact valve for sizes 23-29 mm when compared to the corresponding C-E valve. The effective orifice area and effective orifice area index was no different between the two valves. Satisfactory hemodynamics are seen in the smaller prostheses when valves are matched for BSA and when aortic annular enlargement is performed when necessary.
1990年10月至1992年6月期间，89例患者使用完整猪生物瓣膜进行了主动脉瓣置换术。他们的平均年龄（±标准差）为74.6±7.8岁（范围48至92岁）。75%的患者为纽约心脏协会（NYHA）心功能Ⅲ-Ⅳ级，79例（89%）患有主动脉瓣狭窄（AS）或AS/主动脉瓣关闭不全（AI），10例（11%）曾接受过心脏手术，25例（32%）的射血分数（EF）<0.50。相关手术包括冠状动脉旁路移植术（CABG）45例（51%）、室间隔心肌切除术13例（15%）、瓣环扩大术8例（9%）、左心室动脉瘤切除术1例、升主动脉置换术1例和主动脉弓置换术1例。住院死亡率为4例（4.5%）。在术后7天、6周和12个月时，采用二维超声心动图及多普勒评估血流动力学，并与130个标准的Carpentier-Edwards（C-E）猪生物瓣膜进行比较。随访时，2例患者出现2/4级瓣周AI。完整瓣膜的跨瓣压差如下：21mm-16.9±7.4mmHg；23mm-18.9±6.2mmHg；25mm-17.1±5.4mmHg；27mm-15.0±3.7mmHg；29mm-15.0±2.1mmHg。与标准的Carpentier-Edwards猪生物瓣膜相比，21mm的完整瓣膜与C-E瓣膜的压差相同。然而，与相应的C-E瓣膜相比，23-29mm尺寸的完整瓣膜跨瓣压差略高。两种瓣膜的有效瓣口面积及有效瓣口面积指数无差异。当根据体表面积匹配瓣膜并在必要时进行主动脉瓣环扩大术时，较小尺寸的瓣膜可观察到满意的血流动力学。
