应用不同品牌机械瓣行主动脉瓣置换术患者的血流动力学变化

Hemodynamic Changes after Aortic Valve Replacement with Different Types of 19-mm Mechanical Heart Valves

目的探讨应用不同品牌19 mm机械瓣行单纯主动脉瓣置换术后早期血流动力学变化情况。方法回顾性分析2007年1月至2012年1月北京安贞医院116例单纯主动脉瓣狭窄患者行主动脉瓣置换术后血流动力学变化,其中男61例、女55例,年龄(52±13)岁。根据使用的瓣膜品牌将患者分为3组:SJ.Regent瓣膜组,38例(33%),男20例、女18例,平均年龄(52±15)岁;Carbomedics瓣膜组,40例(34%),男21例、女19例,平均年龄(51±17)岁。On-X瓣膜组,38例(33%),男20例、女18例,平均年龄(55±16)岁。比较患者术前和术后左心室收缩期末内径、左心室舒张期末内径、射血分数(EF)值、室间隔厚度、左心室壁厚度、主动脉瓣瓣上流速、跨瓣压差以及术后有效瓣口面积指数(EOAI)。结果三组患者术前及术后的左心室收缩期末内径、左心室舒张期末内径、EF值、室间隔厚度、左心室壁厚度差异均无统计学意义(P>0.05)。主动脉瓣瓣上流速和跨瓣压差术前、术后有差异有统计学意义。SJ.Regent瓣膜组和Carbomedics瓣膜组患者较On-X瓣膜组患者的术后主动脉瓣瓣上流速[(244.30±33.67)cm/s vs.(249.69±79.13)cm/s vs.(294.83±52.05)cm/s]和跨瓣压差[(27.77±3.33)mm Hg vs.(33.58±18.90)mm Hg vs.(38.56±13.21)mm Hg]明显偏小,其差异有统计学意义。结论运用19 mm机械瓣进行主动脉瓣置换术,SJ.Regent和Carbomedics瓣膜较On-X瓣膜有更好的血流动力学效果。

Objective： To investigate hemodynamic changes in the early postoperative period of isolated aorticvalve replacement （AVR） with different types of 19-mm mechanical heart valves. Methods Clinical data of 116 patientswith aortic stenosis who underwent AVR in Beijing Anzhen hospital from January 2007 to January 2012 were retrospectivelyanalyzed. There were 61 male and 55 female patients with their age of 52±13 years. All the patients were divided into 3 groups according to different types of mechanical heart valves they received. In SJ. Regent valve group,there were 38 patients（33%） including 20 males and 18 females with their average age of 52±15 years. In Carbomedics valve group,there were 40 patients （34%）including 21 males and 19 females with their average age of 51±17 years. In On-X valve group,there were 38 patients （33%） including 20 male and 18 female patients with their average age of 55±16 years. Preoperative and postoperative left ventricular end-systolic diameter （LVESD）,left ventricular end-diastolic diameter （LVEDD）,ejection fraction （EF）,interventricular septal thickness,left ventricular wall thickness,trans-aortic valve velocity and pressure,and postoperative effective orifice area index （EOAI） were compared. Results There was no statistical difference in preoperativeand postoperative LVESD,LVEDD,EF,interventricular septum thickness and left ventricular wall thickness among the 3 groups （P〉0.05）. There was statistical difference in preoperative and postoperative trans-aortic valve velocity and pressure. Trans-aortic valve velocity of SJ. Regent valve group and Carbomedics valve group （244.30±33.67 cm/s vs. 249.69±79.13 cm/s vs. 294.83±52.05 cm/s） and trans-aortic valve pressure of SJ.Regent valve group and Carbomedics valve group （27.77±3.33 mm Hg vs. 33.58±18.90 mm Hg vs. 38.56±13.21 mm Hg） were significantly smaller than those of On-X valve group. Conclusion St. Regent and Carbomedics mechanical heart valves demonstrate better hemodynamicsin AVR patients receiving 19-mm mechanical heart valves.