新颖的 Perceval 尺寸测量技术:单中心经验

Rafik Margaryan, Giovanni Concistre', Giacomo bianchi, Marco Solinas
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摘要

本研究的目的是比较无缝合瓣膜的旧式(制造商推荐的)和新式(以机构为基础的)尺寸测量技术。材料 226 例连续接受主动脉瓣置换术的患者均使用 Perceval 无缝合瓣膜(Corcym),并进行了造影剂增强 CT 扫描。最终决定合适尺寸的依据是术中钝器的尺寸。简而言之,我们在 CT 扫描中测量了瓣环表面和周长,以估算假体的尺寸。新的尺寸测量技术只使用 Perceval 的白色闭孔器,它应该以轻微的摩擦力穿过瓣环,这实际上低于制造商的建议尺寸。结果 手术死亡率为 1 例(0.44%)。各组均未发生假体移位和瓣环破裂。新手术组的平均随访时间较短(3.3 ± 2.0 vs 9.7 ± 1.6,P < 0.01)。出院时,使用新尺寸技术的患者人工瓣膜梯度较小(13.4 ± 5.0 vs 15.2 ± 5.5,P = 0.02)。在随访过程中,新的瓣膜尺寸更不容易发生需要干预的退化(13.4 ± 5.0 vs 15.2 ± 5.5,p = 0.02)。22.6%的过大瓣膜对瓣膜梯度增加和结构退变有显著影响(p < 0.05)。结论 新的尺寸测量技术安全且可重复。它似乎能为Perceval无缝合瓣膜带来更好的近期和远期效益,降低术后梯度,减少结构退化的可能性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Novel Perceval Sizing Technique: Single Center Experience
Objective Aim of this study was to compare old (manufacturer recommended) and new (institution based) sizing techniques for sutureless valve. Materials A 226 consecutively operated patients underwent aortic valve replacement with Perceval sutureless valve (Corcym) and had CT scan with contrast enhancement were included to this study. The final decision of appropriate size is based on intra-operative obturator sizing. Briefly, we have measured on the CT scans the annular ring surface and perimeter in order to estimate the prosthesis size. New sizing technique uses only white obturator of Perceval and it should passe trough the annulus with slight friction, which practically under-sizes with respect to manufacturer's recommendations. Results The operative mortality was 1 (0.44 %). There were no prosthesis migration neither annular rupture in any group. The mean follow up was lower in new group (3.3 ± 2.0 vs 9.7 ± 1.6, p < 0.01). At the discharge the patients who have used the new sizing technique had less gradient on the prosthetic valve (13.4 ± 5.0 vs 15.2 ± 5.5, p = 0.02). The new sizing was less prone to degeneration at the follow-up which would require intervention (13.4 ± 5.0 vs 15.2 ± 5.5, p = 0.02). Oversizing of 22.6% had significant role on valve gradient increase and structural degeneration (p < 0.05). Conclusions New sizing technique is safe and reproducible. It seem to deliver better immediate and long term benefits for Perceval sutureless valve, less postoperative gradient, less probability or structural degeneration.
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