Aortic Valve Replacement with a Conventional Stented Bioprosthesis versus Sutureless Bioprosthesis: a Study of 763 Patients

Abstract Objective: The aim of this retrospective study was to compare early postoperative outcomes after aortic valve replacement (AVR) with sutureless bioprostheses and conventional stented bioprostheses implanted through median sternotomy. Methods: From January 2011 to December 2016, 763 patients underwent aortic valve replacement with bioprostheses; of these, 139 received a Perceval S sutureless valve (Group A) and 624 received a Perimount Magna Ease valve (Group B). These groups were further divided into A1 (isolated Perceval AVR), A2 (Perceval AVR with coronary artery bypass grafting [CABG]), B1 (isolated conventional stented bioprosthesis), and B2 (conventional stented bioprosthesis + CABG). Results: Patients in Group A were older (mean 74 years vs. 71 years; P<0.0001), predominantly women (53% vs. 32%; P<0.0001), had a higher logistic EuroSCORE (3.26 vs. 2.43; P<0.001), more preoperative atrial fibrillation (20% vs. 13%; P=0.03), and had a lower reopening rate for bleeding (2.1% vs. 6.7%; P=0.04). Compared to Group B1, Group A1 had shorter cross-clamp (mean 40 min vs. 57 min; P≤0.0001) and bypass times (mean 63 min vs. mean 80 min; P=0.02), and they bled less postoperatively (mean 295 ml vs. mean 393 ml; P=0.002). The mean gradient across Perceval valve was 12.5 mmHg while its effective orifice area was 1.5 cm2. Conclusion: In our retrospective study of 763 patients, sutureless valve group patients are older, mostly women, more symptomatic preoperatively, and have higher logistic EuroSCORE. They have shorter cross-clamp and bypass times, less postoperative bleeding, and reduced incidence of reopening. Further studies are needed to evaluate the clinical benefits in short, mid, and long-terms.

摘要 目的：本项回顾性研究旨在对比经正中胸骨切开术（median sternotomy）植入的无缝合生物瓣膜（sutureless bioprostheses）与传统带支架生物瓣膜（conventional stented bioprostheses）行主动脉瓣置换术（aortic valve replacement, AVR）后的早期术后结局。
方法：2011年1月至2016年12月期间，共763例患者接受生物瓣膜主动脉瓣置换术；其中139例植入Perceval S无缝合瓣膜（A组），624例植入Perimount Magna Ease瓣膜（B组）。进一步将两组划分为A1（单纯Perceval瓣膜主动脉瓣置换术）、A2（Perceval瓣膜主动脉瓣置换术联合冠状动脉旁路移植术（coronary artery bypass grafting, CABG））、B1（单纯传统带支架生物瓣膜置换术）及B2（传统带支架生物瓣膜置换术联合CABG）四个亚组。
结果：A组患者年龄更大（平均74岁 vs 71岁；P<0.0001），女性占比更高（53% vs 32%；P<0.0001），术前Logistic EuroSCORE评分更高（3.26 vs 2.43；P<0.001），术前心房颤动发生率更高（20% vs 13%；P=0.03），但术后因出血再次开胸率更低（2.1% vs 6.7%；P=0.04）。与B1亚组相比，A1亚组的主动脉阻断时间（cross-clamp time）平均为40min（vs 57min；P≤0.0001），体外循环时间（bypass time）平均为63min（vs 80min；P=0.02），且术后出血量更少（平均295ml vs 393ml；P=0.002）。Perceval瓣膜的平均跨瓣压差为12.5mmHg，有效瓣口面积为1.5cm²。
结论：本项纳入763例患者的回顾性研究显示，无缝合瓣膜组患者年龄更大、以女性为主、术前症状更显著且Logistic EuroSCORE评分更高。其主动脉阻断时间与体外循环时间更短，术后出血量更少，再次开胸发生率更低。未来仍需开展进一步研究以评估其短期、中期及长期临床获益。