HancockⅡUltra生物瓣行主动脉置换术后早期患者的血流动力学评价

Early hemodynamic evaluation of aortic valve replacement with Hancock Ⅱ Ultra valve

目的HancockⅡUltra有支架生物瓣膜在主动脉瓣置换手术后早期血流动力学变化。方法行单一主动脉瓣置换手术患者60例，随机分为两组，每组30例，分别使用HancockⅡUltra生物瓣膜和HancockⅡ生物瓣膜，术中测量实际瓣环直径，术后30天内及3个月分别行超声心动测量跨瓣血流峰速、跨瓣压差、有效瓣口面积指数及左室重量指数。结果HancockⅡUltra生物瓣组患者术后3个月左心室重量指数、跨瓣血流峰速及跨瓣压差均有显著改善。实测瓣环直径为23～25mm和≥26mm的患者，术后3个月跨瓣血流峰速、有效瓣环面积指数、左室流出道直径均无显著性差异；而实测瓣环直径≤23mm的患者，血流峰速[（2．26±0．05）nr／s对（2．57±0．06）m／s，t=2．07，P〈0．05]、平均压差[（11．40±1．30）mmHg（1mmHg=0．133kPa）对（13．10±1．50）mmHg，t=2．09，P〈0．05]、有效瓣环面积指数[（0．79±0．13）cm2／m2对（0．71±0．02）cm2／m2，t=2．06，P〈0．05]、左心室重量指数[（119．10±11．10）g对（133．20±16．40）g，t=2．67，P〈0．05]、左心室流出道直径[（20．40±0．30）mm对（18．90±0．20）mm，t=2．23，P〈0．05]，HancockⅡUltra瓣组指标均优于HancockⅡ组。结论Han—cockⅡUltra有支架生物瓣膜行主动脉置换，术后早期患者血流动力学结果满意，尤其适用于主动脉根部狭小患者，长期效果有待进一步随访。

Objective To study the aortic valve replacement with Hancock H Ultra valve and its early hemodynamic results. Methods The 30 patients who received Hancock H Ultra aortic valve replacement at our hospital were matched 1 ： 1 with 30 patients who received Hancock Ⅱ on variables known to affect hemodynamic measurements ： size of valtve, age, sex, and body surface area. Early postoperative transthoraeic echocardiography was performed in all patients. Results 3 months postoperatively, Hancock H Ultra valves had significantly lower transvalular gradients, velocity, left ventricle mass index and larger effective orifice area. Compared with Hancock H valves, in ≤22 mm group, Hancock H Ultra valves had significantly lower transvalular velocity[ （2.26 ±0.05 ） vs （ 2.57±0.06 ） , t = 2.07, P 〈 0.05 ] , lower transvalular mean gradients [（11.4±1.3） vs（13.1 ±1.5）, t=2.09, P〈0.05], higher effective orifice area[（0.79±0.13）vs（0.71 ±0.02）, t= 2.06, P 〈 0.05 ] , lower left ventricle mass index[ （ 119.1 ± 11.1 ） vs （ 133.2 ±16.4 ） , t = 2.67, P 〈 0.05] and bigger left ventricle outflow tract （20.4 ± 0. 3 vs 18.9 ±0.2, t = 2.23, P 〈 0.05 ）. Conclusion The Hancock Ⅱ Ultra valve has more favorable early postoperative hemodynamies than the HancockⅡ, especially for the small aortic ring patients.