小主动脉瓣环患者应用小口径生物瓣的临床疗效观察

Clinical observation of small-sized bioprosthetic valve in the treatment of patients with small aortic root

目的回顾性分析行小口径(≤21 mm)生物瓣置换和机械瓣置换的小主动脉瓣环患者的临床资料,比较生物瓣置换术后患者血流动力学与机械瓣置换的差异,探讨在小主动脉瓣环的患者中应用小口径生物瓣行主动脉瓣置换术的可行性及安全性。方法收集2020年11月至2022年8月在武汉亚洲心脏病医院接受治疗的147例小主动脉瓣环患者临床资料和治疗情况,其中机械瓣膜组74例,生物瓣膜组73例。所有患者均符合主动脉瓣置换术手术指征,均行小口径的瓣膜置换。收集患者基线资料、既往病史、术前及术后超声心动图结果、手术相关数据等指标。结果两组患者体外循环时间、主动脉阻断时间比较无明显统计学差异(P>0.05)。21mm生物瓣与20mm机械瓣比较,术后左心房内径[(36.4±7.0)mm比(37.2±10.2)mm,P>0.05],左心室舒张末期内径[(45.7±5.0)mm比(44.4±7.0)mm,P>0.05]未见统计学差异,生物瓣术后射血分数优于机械瓣[(61.1±7.0)%比(57.4±10.4)%,P=0.034],生物瓣术后主动脉跨瓣压峰值差劣于机械瓣[(25.8±7.5)mmHg比(21.3±6.5)mmHg,P=0.002],但两者的压差降低率无明显差异(P=0.617)。19mm生物瓣与18mm机械瓣比较,术后射血分数无明显差异[(61.2±8.0)%比(60.1±5.1)%,P>0.05],左心室舒张末期内径无明显差异[(47.3±4.9)mm比(47.5±3.1)mm,P>0.05],主动脉跨瓣压峰值差无明显差异[(26.9±7.0)mmHg比(26.1±5.9)mmHg,P>0.05],且两者压差降低率无明显统计学差异(P>0.05)。术后生物瓣左心房内径优于机械瓣[(34.8±8.8)mm比(37.2±12.4)mm,P<0.001]。两组患者术后均未出现脑栓塞或脑出血等脑部并发症,随访过程中也未出现瓣膜功能障碍或卡瓣的情况。结论在小主动脉瓣环患者中用小口径的生物瓣行主动脉瓣置换术是安全有效的,其可获得的临床疗效不劣于机械瓣。

Objective By retrospectively analyzing the clinical data of patients with small aortic root who underwent small-sized(≤21 mm)bioprosthetic valve replacement and mechanical valve replacement,and comparing the hemodynamics of patients after bioprosthetic valve replacement with that of mechanical valve replacement,we investigated the feasibility and safety of applying small-sized bioprosthetic valves for aortic valve replacement in patients with small aortic roots.Methods Clinical data of 147 patients with small aortic roots treated in Wuhan Asian Heart Hospital from November 2020 to August 2022 were collected,of which 74 cases were in the mechanical valve group and 73 cases were in the bioprosthetic valve group.All patients met the surgical indications for aortic valve replacement and underwent small-sized valve replacement.Indicators such as patients'baseline data,past medical history,preoperative and postoperative echocardiographic results and surgery-related data were collected and compared.Results There was no significant difference in cardiopulmonary bypass time and aortic occlusion time between the two groups(P>0.05).Comparison between 21 mm bioprosthetic valve and 20 mm mechanical valve,there was no significant difference of the left atrial diameter[(36.4±7.0)mm vs.(37.2±10.2)mm,P>0.05]and the LVEDD[(45.7±5.0)mm vs.(44.4±7.0)mm,P>0.05]between the two groups;the postoperative ejection fraction of bioprosthetic valve was better than that of mechanical valve[(61.1±7.0)%vs.(57.4±10.4)%,P=0.034].The PG of bioprosthetic valve was inferior to that of mechanical valve[(25.8±7.5)mmHg vs.(21.3±6.5)mmHg,P=0.002],but there was no significant difference in the reduction rate of PG between the two groups(P=0.617).Comparison between 19 mm bioprosthetic valve and 18mm mechanical valve,there was no significant difference of the postoperative ejection fraction[(61.2±8.0)%vs.(60.1±5.1)%,P>0.05],the LVEDD[(47.3±4.9)mm vs.(47.5±3.1)mm,P>0.05]and the PG[(26.9±7.0)mmHg vs.(26.1±5.9)mmHg,P>0.05]between the two groups;and there was no significant difference in the reduction rate of pressure difference between the two groups(P>0.05).The left atrial diameter of the bioprosthetic valvewas better than that of the mechanical valve[(34.8±8.8)mm vs.(37.2±12.4)mm,P<0.001].No cerebral complications such as cerebral embolism or cerebral hemorrhage occurred after surgery and no valvular dysfunction or valve jam occurred during follow-up in both the groups.Conclusion Aortic valve replacement with small-diameter bioprosthetic valves in patients with small aortic roots is safe and effective,and its clinical outcomes are not inferior to those of mechanical valves.