Sintek C F, Fletcher A D, Khonsari S
Regional Department of Cardiac Surgery, Kaiser Permanente Medical Center, Los Angeles, California, USA.
J Heart Valve Dis. 1996 Nov;5 Suppl 3:S308-13.
Aortic root enlargement in the elderly patient prolongs aortic valve replacement procedures and may be problematic if the root is calcified. Mechanical valves have superior hemodynamics compared to tissue valves in the smaller sizes but are often contraindicated in the older patient.
Between January 1993 and November 1995, we implanted 80 Freestyle (Medtronic, Irvine, CA) stentless porcine valves using the freehand subcoronary technique. Twenty-seven of the patients had small aortic roots with an average age of 76.3 years (69-84). Seven patients received size 19 valves and 20 patients had size 21 valves.
The average echocardiographic gradient at hospital discharge was 17.9 mmHg (12.1-23.0) for size 19 valves and 15.3 mmHg (5.7-27.9) for size 21. At one year postoperative follow up the average gradient had decreased to 12.9 mmHg (9.3-17.5) for size 19 and 8.0 mmHg (2.2-19.3) for size 21 valves. Effective orifice areas increased from 1.09 cm2 at the time of discharge to 1.29 cm2 at one year follow up for size 19 valves, and from 1.30 cm2 to 1.56 cm2 for size 21. No patient had more than mild aortic insufficiency at most recent follow up.
This stentless porcine prosthesis has excellent hemodynamics in the smaller valve sizes which improve at least during the first year following surgery. We feel that it is the valve of choice in older patients with small aortic roots.
老年患者主动脉根部扩大延长了主动脉瓣置换手术时间，若根部钙化则可能出现问题。在较小尺寸方面，机械瓣膜相比于组织瓣膜具有更优的血流动力学表现，但老年患者常禁忌使用。
1993年1月至1995年11月期间，我们采用徒手冠状动脉下技术植入了80枚Freestyle（美敦力公司，加利福尼亚州欧文市）无支架猪瓣膜。其中27例患者主动脉根部较小，平均年龄76.3岁（69 - 84岁）。7例患者接受19号瓣膜，20例患者接受21号瓣膜。
出院时，19号瓣膜的平均超声心动图压差为17.9 mmHg（12.1 - 23.0），21号瓣膜为15.3 mmHg（5.7 - 27.9）。术后一年随访时，19号瓣膜的平均压差降至12.9 mmHg（9.3 - 17.5），21号瓣膜降至8.0 mmHg（2.2 - 19.3）。有效瓣口面积从出院时的1.09 cm²增加至一年随访时的1.29 cm²（19号瓣膜），21号瓣膜则从1.30 cm²增加至1.56 cm²。在最近一次随访中，无一例患者存在超过轻度的主动脉瓣关闭不全。
这种无支架猪瓣膜在较小瓣膜尺寸下具有出色的血流动力学表现，且至少在术后第一年有所改善。我们认为它是主动脉根部较小的老年患者的首选瓣膜。
