17mm St.Jude Regent瓣术后中远期临床效果和在体血流动力学评价

Mid-long-term Clinical Results and Hemodynamic Evaluation of Aortic Valve Replacement with 17 mm St. Jude Medical Regent Valve

目的观察17mm St.Jude Regent机械瓣置入人体后中远期临床效果,测量其有效瓣口面积,评价是否发生瓣膜-患者不匹配(prosthesis-patient mismatch,PPM)现象,并探索PPM现象对术后患者心功能的影响。方法 44例心脏瓣膜病患者接受二尖瓣及主动脉瓣置换术,所有患者因主动脉瓣环小而置入17mm St.JudeRegent机械瓣。对该组患者进行随访研究,分别于术前及术后12～55月,运用心脏彩色超声心动图测量17mmSt.Jude Regent机械瓣的在体有效瓣口面积和各血流动力学指标,并采用NYHA分级标准评估患者术后心功能。结果全部患者通过门诊或电话完成随访,其中有39例(88.6%)患者在术后12～55月完成心脏彩色超声心动图检查,随访期内共有1例患者(2.27%)发生心功能衰竭死亡;按照当前国际有效瓣口面积指数(effective orifice areaindex,EOAI)标准(EOAI≤0.85cm2/m2即可出现PPM),33例患者(82.1%)出现PPM,其中13例患者(30.8%)发生严重PPM(EOAI≤0.65cm2/m2);术后患者主动脉瓣跨瓣压差、左室质量(LVmass)及左室质量指数(LVmassI)均较术前降低(P<0.05),按照NYHA分级标准评价患者术后心功能示恢复良好(P<0.05)。结论①小主动脉瓣环患者采用17mm St.Jude Regent瓣避免了行主动脉瓣环扩大术,且能取得较好的中远期临床疗效。②按照当前国际EOAI标准,PPM现象不会严重影响17mm St.Jude Regent瓣膜置换术后患者的中远期疗效。

Objective To investigate the mid-long-term clinical results of aortic valve replacement with 17 mm St. Jude medical regent valve with hemodynamic evaluation including the measurement of effective orifice area, the occurrence of prosthesis-patient mismatch （PPM） and its affect on heart function. Methods There were 44 patients accepted aortic valve replacement with 17 mm St. Jude medical regent valve because of small aortic annulus. Before the operation and during the postoperative follow-up, color doppler echocardiography was used to measure the hemodynamic parameters, such as left ventricular mass （LVmass）, effective orifice area （EOA） and effective orifice area index （EOAI）, etc.. Results Transthoracic echocardiographic data were obtained from 39 of 44 patients （88.6%）at 12 55 months after surgery. One （2. 27%） died of heart failure in 1 year. According to the current standard of PPM （EOAI〈0.85 cm2/m2）, a3 cases （82.1%） had PPM, 13 cases （30.8M） had severe PPM with an EOAI≤ 40.65 cm2/m2. After the operation, there were significant decreases in LVAo PG （19-1-8） mmHg and left ventricular mass index （LVmass I ） （86.6 23.3） g/m2 （P〈0.05）. The assessment for physical capacity according to NYHA classification： 41 patients improved to class 11 or better and 2 patients improved to classIII （P%0.05）. Conclusion The patients with small aortic annulus may obtain satisfactory clinical results after AVR with 17 mm St. Jude medical regent valve, PPM seems not affect the mid-long-term results.