{"title":"65岁以下患者主动脉瓣狭窄的主动脉瓣置换术","authors":"R. Coelho, T. Bourguignon, A. Bernard","doi":"10.1016/j.acvdsp.2023.04.006","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><p><span><span>Aortic valve stenosis is the most common valve disease in the world, with particularly poor prognosis if left untreated. Its management in young patients is based on surgical </span>aortic valve<span> replacement (bioprosthesis or mechanical prosthesis, and Ross or Ozaki technique), and rarely percutaneous (TAVR). In this population, the choice of the technique used is of primary importance in terms of hemodynamic<span> performance and durability. The objective of this work is to compare 5 different techniques used in the management of aortic stenosis </span></span></span>in patients under 65 years old at CHRU of Tours.</p></div><div><h3>Method</h3><p>We conducted a retrospective, single-center, observational study at the CHRU of Tours. Five cohorts (mechanical prosthesis, INSPIRIS bioprosthesis, Ross, Ozaki and TAVR) were compared in terms of pre-, per- and postoperative, clinical and hemodynamic parameters.</p></div><div><h3>Results</h3><p><span>We included 163 patients under 65-years-old with aortic stenosis operated at the CHRU of Tours between January 2015 and October 2021. Hemodynamically, after stratification on the prosthetic caliber, the best results were found with the Ozaki and Ross techniques, followed by TAVR, the INSPIRIS bioprosthesis and finally the mechanical prosthesis. A severe prosthesis-patient mismatch rate of 10% was found in all patients, with no significant difference between the different techniques (</span><em>P</em> <!-->=<!--> <!-->0.1827). Clinically, there was no significant difference between the groups in terms of mortality or re-intervention related to the aortic valve after a mean follow-up of 19.2 months (<em>P</em> <!-->=<!--> <span>0.6545). However, pacemaker implantation was significantly higher in the TAVR group (</span><em>P</em> <!-->=<!--> <!-->0.0178).</p></div><div><h3>Conclusion</h3><p>Each surgical and percutaneous technique has its specific advantages and complications. The excellent short-term hemodynamic parameters of the Ross and Ozaki techniques seem to encourage the use of these techniques in the management of aortic stenosis in young patients. More powerful studies with a longer follow-up time would allow to confirm these preliminary results.</p></div>","PeriodicalId":8140,"journal":{"name":"Archives of Cardiovascular Diseases Supplements","volume":"15 3","pages":"Page 245"},"PeriodicalIF":18.0000,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Aortic valve replacement for aortic stenosis in patients under 65-years-old\",\"authors\":\"R. Coelho, T. Bourguignon, A. Bernard\",\"doi\":\"10.1016/j.acvdsp.2023.04.006\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><p><span><span>Aortic valve stenosis is the most common valve disease in the world, with particularly poor prognosis if left untreated. Its management in young patients is based on surgical </span>aortic valve<span> replacement (bioprosthesis or mechanical prosthesis, and Ross or Ozaki technique), and rarely percutaneous (TAVR). In this population, the choice of the technique used is of primary importance in terms of hemodynamic<span> performance and durability. The objective of this work is to compare 5 different techniques used in the management of aortic stenosis </span></span></span>in patients under 65 years old at CHRU of Tours.</p></div><div><h3>Method</h3><p>We conducted a retrospective, single-center, observational study at the CHRU of Tours. Five cohorts (mechanical prosthesis, INSPIRIS bioprosthesis, Ross, Ozaki and TAVR) were compared in terms of pre-, per- and postoperative, clinical and hemodynamic parameters.</p></div><div><h3>Results</h3><p><span>We included 163 patients under 65-years-old with aortic stenosis operated at the CHRU of Tours between January 2015 and October 2021. Hemodynamically, after stratification on the prosthetic caliber, the best results were found with the Ozaki and Ross techniques, followed by TAVR, the INSPIRIS bioprosthesis and finally the mechanical prosthesis. A severe prosthesis-patient mismatch rate of 10% was found in all patients, with no significant difference between the different techniques (</span><em>P</em> <!-->=<!--> <!-->0.1827). Clinically, there was no significant difference between the groups in terms of mortality or re-intervention related to the aortic valve after a mean follow-up of 19.2 months (<em>P</em> <!-->=<!--> <span>0.6545). However, pacemaker implantation was significantly higher in the TAVR group (</span><em>P</em> <!-->=<!--> <!-->0.0178).</p></div><div><h3>Conclusion</h3><p>Each surgical and percutaneous technique has its specific advantages and complications. The excellent short-term hemodynamic parameters of the Ross and Ozaki techniques seem to encourage the use of these techniques in the management of aortic stenosis in young patients. More powerful studies with a longer follow-up time would allow to confirm these preliminary results.</p></div>\",\"PeriodicalId\":8140,\"journal\":{\"name\":\"Archives of Cardiovascular Diseases Supplements\",\"volume\":\"15 3\",\"pages\":\"Page 245\"},\"PeriodicalIF\":18.0000,\"publicationDate\":\"2023-06-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Archives of Cardiovascular Diseases Supplements\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1878648023001453\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Archives of Cardiovascular Diseases Supplements","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1878648023001453","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
Aortic valve replacement for aortic stenosis in patients under 65-years-old
Introduction
Aortic valve stenosis is the most common valve disease in the world, with particularly poor prognosis if left untreated. Its management in young patients is based on surgical aortic valve replacement (bioprosthesis or mechanical prosthesis, and Ross or Ozaki technique), and rarely percutaneous (TAVR). In this population, the choice of the technique used is of primary importance in terms of hemodynamic performance and durability. The objective of this work is to compare 5 different techniques used in the management of aortic stenosis in patients under 65 years old at CHRU of Tours.
Method
We conducted a retrospective, single-center, observational study at the CHRU of Tours. Five cohorts (mechanical prosthesis, INSPIRIS bioprosthesis, Ross, Ozaki and TAVR) were compared in terms of pre-, per- and postoperative, clinical and hemodynamic parameters.
Results
We included 163 patients under 65-years-old with aortic stenosis operated at the CHRU of Tours between January 2015 and October 2021. Hemodynamically, after stratification on the prosthetic caliber, the best results were found with the Ozaki and Ross techniques, followed by TAVR, the INSPIRIS bioprosthesis and finally the mechanical prosthesis. A severe prosthesis-patient mismatch rate of 10% was found in all patients, with no significant difference between the different techniques (P = 0.1827). Clinically, there was no significant difference between the groups in terms of mortality or re-intervention related to the aortic valve after a mean follow-up of 19.2 months (P = 0.6545). However, pacemaker implantation was significantly higher in the TAVR group (P = 0.0178).
Conclusion
Each surgical and percutaneous technique has its specific advantages and complications. The excellent short-term hemodynamic parameters of the Ross and Ozaki techniques seem to encourage the use of these techniques in the management of aortic stenosis in young patients. More powerful studies with a longer follow-up time would allow to confirm these preliminary results.
期刊介绍：
Archives of Cardiovascular Diseases Supplements is the official journal of the French Society of Cardiology. The journal publishes original peer-reviewed clinical and research articles, epidemiological studies, new methodological clinical approaches, review articles, editorials, and Images in cardiovascular medicine. The topics covered include coronary artery and valve diseases, interventional and pediatric cardiology, cardiovascular surgery, cardiomyopathy and heart failure, arrhythmias and stimulation, cardiovascular imaging, vascular medicine and hypertension, epidemiology and risk factors, and large multicenter studies. Additionally, Archives of Cardiovascular Diseases also publishes abstracts of papers presented at the annual sessions of the Journées Européennes de la Société Française de Cardiologie and the guidelines edited by the French Society of Cardiology.
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