有支架与无支架生物瓣膜行主动脉瓣置换临床对比研究

Comparative study on aortic valve replacement with stentless and stented bioprosthetic valve

目的 探讨无支架Medtronic生物瓣行主动脉瓣置换的临床效果。方法 将 6 8例同期施行主动脉瓣置换术病人分为 2组 ,38例行无支架Medtronic生物瓣置换 ,30例对照组行有支架生物瓣置换。术前及术后 2个月随访行超声心动图检查。结果 无支架组和有支架组病人术后各项检测指标差异有显著性意义。无支架组跨瓣压差 (18 0± 3 7)mmHg(1mmHg =0 133kPa)明显低于有支架组(33 7± 8 3)mmHg;左室射血分数 0 6 5± 0 0 5 ,明显高于有支架组 0 5 6± 0 0 8;左室收缩末内径和左室舒张末内径分别为 (3 8± 0 8)cm和 (4 5± 0 4 )cm ,明显低于有支架组 (4 2± 1 4 )cm和 (5 1± 0 9)cm ;无支架组瓣环内径 (2 2 1± 1 8)mm大于有支架组 (19 5± 1 7)mm。结论 无支架Medtronic生物瓣较有支架生物瓣具有较低的跨瓣压差和良好的血流动力学 ,能促进左室功能的恢复。

Ovbective To evaluate the clinical results of the aortic valve replacement with Medtronic stentless bioprosthetic valve. Methods 68 patients with AVR were divided into two groups,group I (38 patients) with Medtronic stentless bioprosthetic valve,and group II (30 patients) with stent aortic valve. Doppler echocardiograms were recorded before operation and 2 months after AVR. Results After operation,aortic valve pressure gradient (AVPG),[(18.0±3.7)mmHg vs. (33.7±8.3)mmHg];left ventricular ejection fraction (LVEF),[(65.1±5.4)% vs. (55.6±8.4)%];left ventricular systolic diameter (LVSD) [(3.8±0.8)cm vs. (4.2±1.4)cm],left ventricular diastolic diameter (LVDD) [(4.5±0.4)cm vs. (5.1±0.9)cm],and diameter of aortic valves [(22.1±1.8)mm vs. (19.5±1.7)mm] were significantly different between group I and group II (P<0.05). Conclusion Medtronic stentless bioprosthetic valve replacement,it could finally restore the left ventricular function through a lower transvalvulas pressure gradient and other improved hemo-dynamic indexes,might be more effective according to this study.