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首页> 外文期刊>European journal of cardio-thoracic surgery: Official journal of the European Association for Cardio-thoracic Surgery >Importance of implant technique on risk of major paravalvular leak (PVL) after St. Jude mechanical heart valve replacement: a report from the Artificial Valve Endocarditis Reduction Trial (AVERT).
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Importance of implant technique on risk of major paravalvular leak (PVL) after St. Jude mechanical heart valve replacement: a report from the Artificial Valve Endocarditis Reduction Trial (AVERT).

机译：植入技术对圣裘德机械心脏瓣膜置换术后大瓣周漏（PVL）风险的重要性：人工瓣膜心内膜减少试验（AVERT）的报告。

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OBJECTIVE: To examine risk factors for major paravalvular leak (PVL) events after mechanical heart valve replacement. METHODS: We analyzed outcome of 807 patients randomized into the Artificial Valve Endocarditis Reduction Trial (AVERT). The mean follow-up time was 30.6 months and 21 major PVL events were reported. Three additional major PVL events associated with endocarditis were excluded from analysis. All baseline medical history variables, as well as operative parameters (including use of pledgets and suture technique) were examined using Cox regression. RESULTS: Major PVL was reported after 11 aortic, 9 mitral, and 1 double valve replacement. 6/404 (1.5%) patients with conventional valves experienced a major PVL event versus 15/403 (3.7%) in the Silzone group. 10/172 (5.8%) patients with valve suture technique without pledgets experienced a major PVL event versus 11/635 (1.7%) patients with pledgets. Final multivariable model showed that only suture technique without pledgets (p=0.005) was an independent significant risk factor for major PVL events. Silzone cuff showed a strong trend (p=0.055). CONCLUSIONS: Suture technique without pledgets is an independent significant risk factor for major PVL events. In this study, use of pledgets during valve replacement had a protective effect against subsequent paravalvular leak, supporting the use of buttress reinforcement for valve suture. The use of Silzone cuff, although not statistically significant, showed a strong trend as a risk factor.
机译：目的：检查机械心脏瓣膜置换术后主要瓣周漏（PVL）事件的危险因素。方法：我们分析了807例患者的结果，这些患者被随机分为人工瓣膜减少心内膜炎试验（AVERT）。平均随访时间为30.6个月，并报告了21项重大PVL事件。分析排除了与心内膜炎相关的另外三个主要PVL事件。使用Cox回归检查所有基线病史变量以及手术参数（包括使用质子和缝合技术）。结果：主动脉瓣置换11例，二尖瓣置换9例，双瓣置换1例，报告了主要PVL。 6/404（1.5％）的常规瓣膜患者发生了严重的PVL事件，而Silzone组为15/403（3.7％）。 10/172（5.8％）无瓣膜缝合技术的患者发生了严重的PVL事件，而11/635（1.7％）有瓣膜缝合的患者发生了严重的PVL事件。最终的多变量模型表明，只有缝合术而不进行穿刺术（p = 0.005）是发生重大PVL事件的独立重要危险因素。 Silzone袖口显示出很强的趋势（p = 0.055）。结论：没有承诺的缝合技术是发生重大PVL事件的独立重要危险因素。在这项研究中，在瓣膜置换期间使用楔子对随后的瓣周漏有保护作用，支持在瓣膜缝合中使用支撑件加固。 Silzone袖带的使用尽管无统计学意义，但已显示出作为危险因素的强烈趋势。

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