ステントのない弁は,現代のステント付き弁よりも優れているのでしょうか? 予期的なランダム化試験である
Ayyaz Ali1, James C Halstead, Fay Cafferty
1Department of Cardiothoracic Surgery, Papworth Hospital, Papworth Everard, Cambridge, CB3 8RE, UK.
Circulation
|July 6, 2006
まとめ
ステントのない大動脈バイオプロテシスは,大動脈弁の置換から1年後に,ステント付きの弁と比較して,同様の血液動力学的性能と左心室質量回帰を示しました. しかし,ステントなしの弁は,心室機能障害のある患者の排泄分数を改善する可能性があります.
科学分野:
- 心血管外科手術についてです.
- バイオメディカルエンジニアリング
- 心臓生理学 心臓生理学
背景:
- ステントのない大動脈バイオプレステスがステント付き設計に比べて血液動力学上の優位性があると推定される.
- 将来のランダム化対照試験における直接比較の必要性.
研究 の 目的:
- ステントなしとステント付きの大動脈バイオプロステスの血液動力学的性能と左心室質量回帰を比較する.
- 大動脈弁置換手術を受ける患者の機能的アウトカムを評価する.
主な方法:
- C-E Perimount stented vs. Prima Plus stentless bioprosthesesを比較した前向きのランダム化比較試験で,重度の大動脈弁の狭窄症を有する161人の患者を対象とした.
- エコカルジオグラフィとMRIを用いた左心室質量回帰の評価.
- ヘモダイナミック性能を評価するためにトランスバルブラー・グラデーションの測定.
主要な成果:
- 1年後,ステントのないバイオプロテシスとステント付きバイオプロテシスの間で,左心室質量回帰の有意な差はありません.
- 比較可能なトランスバルブラー・グラデーションを持つ同様の血液動力学的性能は,両方のグループで観察されました.
- 既にある心室機能障害を持つステントなしの弁受容体で観察された左心室放出分数の著しく大きな改善.
結論:
- ステント付きおよびステントなしのバイオプロテシスは,大動脈弁置換手術から1年後の優れた臨床および血液動力学的結果を提供します.
- 第2世代のステント付近心膜バイオプロテシスは,ステントのない弁に比較可能な血液動力学と左心室質量回帰を達成します.
- ステントレス生体義肢は,心室機能障害のある患者の手術後の左心室機能回復を促進する可能性があります.
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