Sidiropoulos A, Hotz H, Tschesnow J, Konertz W
Department of Cardiac Surgery, Charité, Berlin, Germany.
Eur J Cardiothorac Surg. 1997 May;11(5):917-21. doi: 10.1016/s1010-7940(97)01177-9.
Conventional biological and mechanical prostheses have important limitations with regard to their results concerning thrombosis, hemorrhage and long-term durability. Aortic valve replacement with stentless devices results in superior hemodynamic function because obstructing stents and sewing rims are avoided. In addition, no anticoagulation therapy is needed.
From 1 June 1991 until 31 May 1996, 235 patients received aortic valve replacement with stentless aortic porcine bioprostheses. Patients' ages ranged from 24 to 88 years (mean 64 years). In 21.3% of all patients, concomitant procedures were performed. Coronary artery bypass graft (CABG) and mitral valve surgical therapy were the most frequent ones (31 and 12 cases, respectively). Implanted valve sizes ranged from 21 to 29 mm in diameter.
A total of 122 patients received a subcoronary implantation with the lower row performed with interrupted stitches and the upper row with a continuous suture. In 99 cases we performed the inclusion cylinder technique, also with lower interrupted sutures and running upper sutures after adaptation of the coronary ostia into the graft. In the group with small aortic roots, the total root replacement technique (n = 14) was used. Mortality at 30 days was 4.7% (11/235). Echocardiography at discharge postoperatively revealed a mean gradient across the prosthesis of 6 mm Hg. Color Doppler suggested no or trivial regurgitation in 93% of all examined patients and mild regurgitation without clinical symptoms in 7%. Up to now, 98.2% of all discharged patients have been free of valve-related reoperation.
With implantation of stentless bioprostheses, an improved hemodynamic function will be obtained. Almost every aortic root pathology can be safely treated with any of the techniques described. The short and intermediate results seem to be at least equal to any other prostheses or treatment methods. The long-term performance of these devices is still under investigation.
传统的生物和机械瓣膜假体在血栓形成、出血及长期耐用性方面存在重要局限性。采用无支架装置进行主动脉瓣置换可获得更好的血流动力学功能，因为避免了阻塞性支架和缝合边缘。此外，无需抗凝治疗。
1991年6月1日至1996年5月31日，235例患者接受了无支架猪主动脉生物瓣膜置换主动脉瓣手术。患者年龄24至88岁（平均64岁）。21.3%的患者同时进行了其他手术。冠状动脉旁路移植术（CABG）和二尖瓣手术治疗最为常见（分别为31例和12例）。植入瓣膜直径范围为21至29毫米。
共122例患者接受了冠状动脉下植入，下排采用间断缝合，上排采用连续缝合。99例采用包埋圆柱技术，在将冠状动脉开口适配到移植物后，下排也采用间断缝合，上排采用连续缝合。在主动脉根部较小的组中，采用了全根部置换技术（n = 14）。30天死亡率为4.7%（11/235）。术后出院时超声心动图显示假体平均跨瓣压差为6毫米汞柱。彩色多普勒显示，93%的受检患者无反流或仅有微量反流，7%的患者有轻度反流但无临床症状。截至目前，98.2%的出院患者无需进行与瓣膜相关的再次手术。
植入无支架生物瓣膜可改善血流动力学功能。几乎所有主动脉根部病变都可以通过上述任何一种技术安全治疗。短期和中期结果似乎至少与其他任何瓣膜假体或治疗方法相当。这些装置的长期性能仍在研究中。
