Carrel T, Zingg U, Jenni R, Aeschbacher B, Turina M I
Clinic for Cardiovascular Surgery, University Hospital, Zürich, Switzerland.
Ann Thorac Surg. 1996 May;61(5):1418-22. doi: 10.1016/0003-4975(96)00112-9.
Small aortic orifice primarily resulted in heart prosthesis mismatch in a significant number of patients. The Hemodynamic Plus (HP) series of St. Jude Medical heart valves represents an interesting innovation, allowing a larger valve orifice area with an equivalent tissue annulus diameter.
Hemodynamic characteristics of the 21-mm HP St. Jude Medical valve were prospectively compared with those of the standard 21-mm and 23-mm St. Jude Medical valves in three groups of 22 patients. Patients were selected from a database to be rigorously matched for age, sex, body surface area, functional class, underlying lesion, native valve opening area, left ventricular function, and preoperative peak and mean valve gradients. Postoperative evaluation (follow-up ranging from 3 to 24 months; mean, 11.5 months) included clinical examination and echocardiographic studies.
There was no operative mortality or significant perioperative complications. Short-term clinical follow-up was marked by a complete absence of valve-related complications. Presently, all but 1 patient in the 21-mm HP group and 2 in the 21-mm standard group are in New York Heart Association functional class I. Doppler echocardiography-derived mean and maximal pressure gradients were significantly lower in the 21-mm HP group (8.1 +/- 1.9 and 16.4 +/- 3.4 mm Hg) than in the 21-mm standard group (13.4 +/- 3.9 and 21.2 +/- 4.3 mm Hg; p = 0.002 and p = 0.0004, respectively), confirming the better hemodynamic performance already described in in vitro studies. Pressure gradients did not differ significantly between the 21-mm HP and the 23-mm standard groups. The 21-mm HP valve demonstrated the highest performance index; 0.66 +/- 0.08, compared with 0.49 +/- 0.09 for the 21-mm standard valve (p < 0.001) and 0.59 +/- 0.07 for the 23-mm standard valve (p < 0.001).
In vivo hemodynamic performance of the 21-mm HP valve corresponds closely to that of the 23-mm standard valve and is substantially better than that of the 21-mm standard valve. The 21-mm HP St. Jude Medical valve demonstrates excellent hemodynamic characteristics and can be recommended in normal-sized adult patients with narrow aortic root. This valve will minimize the need for aortic annulus enlargement.
小主动脉瓣口在大量患者中主要导致人工心脏瓣膜不匹配。圣犹达医疗公司的Hemodynamic Plus（HP）系列心脏瓣膜是一项有趣的创新，在组织瓣环直径相同的情况下可提供更大的瓣口面积。
在三组各22例患者中，前瞻性比较了21毫米圣犹达医疗HP瓣膜与标准21毫米和23毫米圣犹达医疗瓣膜的血流动力学特征。从数据库中选择患者，使其在年龄、性别、体表面积、功能分级、基础病变、天然瓣膜开口面积、左心室功能以及术前峰值和平均瓣膜压差方面进行严格匹配。术后评估（随访3至24个月；平均11.5个月）包括临床检查和超声心动图研究。
无手术死亡或严重围手术期并发症。短期临床随访显示完全没有瓣膜相关并发症。目前，21毫米HP组除1例患者外、21毫米标准组除2例患者外，其余患者均处于纽约心脏协会功能分级I级。21毫米HP组经多普勒超声心动图得出的平均和最大压力阶差（分别为8.1±1.9和16.4±3.4毫米汞柱）显著低于21毫米标准组（分别为13.4±3.9和21.2±4.3毫米汞柱；p分别为0.002和0.0004），证实了体外研究中已描述的更好的血流动力学性能。21毫米HP组与23毫米标准组之间的压力阶差无显著差异。21毫米HP瓣膜表现出最高的性能指数；为0.66±0.08，而21毫米标准瓣膜为0.49±0.09（p<0.001），23毫米标准瓣膜为0.59±0.07（p<0.001）。
21毫米HP瓣膜的体内血流动力学性能与23毫米标准瓣膜密切对应，且明显优于21毫米标准瓣膜。21毫米圣犹达医疗HP瓣膜表现出优异的血流动力学特征，可推荐用于主动脉根部狭窄的正常体型成年患者。该瓣膜将最大限度减少主动脉瓣环扩大的需求。
