Rapid Deployment of Aortic Bioprosthesis in Elderly Patients With Small Aortic Annulus

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• 作者：Alexis Theron ; MD ; ^{alexis.theron@ap-hm.fr" class="auth_mail" title="E-mail the corresponding author} ; Vlad Gariboldi ; MD ; Dominique Grisoli ; MD ; Nicolas Jaussaud ; MD ; Pierre Morera ; MD ; David Lagier ; MD ; Severine Leroux ; MS ; Cecile Amanatiou ; MS ; Catherine Guidon ; MD ; Alberto Riberi ; MD ; Frederic Collart ; MD
• 关键词：AoA ; aortic annulus ; AVR ; aortic valve replacement ; CPB ; cardiopulmonary bypass ; ELI ; energy loss index ; EOA ; effective orifice area ; iEOA ; indexed EOA ; LV ; left ventricular ; LVOT ; LV outflow tract ; NYHA ; New York Heart Association ; PPM ; patient&ndash ; prosthesis mismatch ; PPR ; periprosthetic regurgitation ; RDAVR ; rapid-deployment AVR ; RR ; regression ratio ; TAVR ; transcatheter AVR
• 刊名：The Annals of Thoracic Surgery
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：101
• 期：4
• 页码：1434-1441
• 全文大小：612 K

文摘

Aortic valve replacement in elderly patients with a small aortic annulus remains challenging. Patient–prosthesis mismatch (PPM) should be prevented without impacting operative mortality. Hemodynamic benefits resulting from rapid-deployment aortic valve replacement with the Edwards Intuity bioprosthesis for this indication were evaluated.

Methods

Elective patients with severe aortic stenosis who required an Edwards Intuity bioprosthesis, size 19 mm and 21 mm, were prospectively included between July 2012 and July 2014. Transthoracic echocardiography was performed preoperatively and at 1-month follow-up.

Results

Sixty-six consecutive patients (mean age, 78 ± 6.4 years; 54.5% women) were included. The Intuity 19 mm was inserted in 29 patients, and the Intuity 21 mm was inserted in 37 patients. No deaths or aortic annulus ruptures occurred. Mean aortic cross-clamp time was 42.7 ± 18.2 minutes. At the 1-month follow-up, mean New York Heart Association classification was 1.6 ± 0.5 versus 2.2 ± 0.8 (p < 0.001). The mean gradient decreased from 59 ± 17.6 mm Hg to 13.7 ± 4.4 mm Hg (p < 0.001). Mean indexed effective orifice area was 0.77 ± 0.17 cm²/m² for the Intuity 19 mm and 1.01 ± 0.32 cm²/m² for the Intuity 21 mm. Twenty-one patients (32%) had a moderate PPM (indexed effective orifice area < 0.85 cm²/m²), and 10 patients (15%) had a severe PPM (indexed effective orifice area < 0.65 cm²/m²). The mean gradient was 15.1 ± 3.5 mm Hg and 16.9 ± 4.9 mm Hg in the moderate PPM group and severe PPM group, respectively (p = 0.3). The left ventricular mass index dramatically decreased from 153.2 ± 32.7 g/m² to 118.4 ± 20.2 g/m² (p < 0.001), and only 1 patient (1.5%) had a periprosthetic regurgitation greater than 1.

Conclusions

Regarding the low rate of severe PPM and the early regression of left ventricular mass, these preliminary studies indicate the potential benefit of the Intuity bioprosthesis in patients with a small aortic annulus. Midterm results should be evaluated.