目的 Hancock Ⅱ Ultra有支架生物瓣膜在主动脉瓣置换手术后早期血流动力学变化.方法 行单一主动脉瓣置换手术患者60例,随机分为两组,每组30例,分别使用Hancock Ⅱ Ultra生物瓣膜和Hancock Ⅱ生物瓣膜,术中测量实际瓣环直径,术后30天内及3个月分别行超声心动测量跨瓣血流峰速、跨瓣压差、有效瓣口面积指数及左室重量指数.结果 Hancock Ⅱ Ultra生物瓣组患者术后3个月左心室重量指数、跨瓣血流峰速及跨瓣压差均有显著改善.实测瓣环直径为23～ 25 mm和≥26 mm的患者,术后3个月跨瓣血流峰速、有效瓣环面积指数、左室流出道直径均无显著性差异；而实测瓣环直径≤23 mm的患者,血流峰速[(2.26±0.05) m/s对(2.57±0.06) m/s,t =2.07,P＜O.05]、平均压差[ (11.40±1.30) mm Hg(1 mm Hg =0.133 kPa)对(13.10 ±1.50) mmHg,t=2.09,P＜0.05]、有效瓣环面积指数[(0.79±0.13) cm2/m2对(0.71±0.02) cm2/m2,t=2.06,P＜0.05]、左心室重量指数[(119.10±11.10)g对(133.20±16.40)g,t=2.67,P＜0.05]、左心室流出道直径[(20.40±0.30) mm对(18.90±0.20) mm,t=2.23,P＜0.05],Hancock Ⅱ Ultra瓣组指标均优于Hancock Ⅱ组.结论 Hancock Ⅱ Ultra有支架生物瓣膜行主动脉置换,术后早期患者血流动力学结果满意,尤其适用于主动脉根部狭小患者,长期效果有待进一步随访.%Objective To study the aortic valve replacement with Hancock Ⅱ Ultra valve and its early hemodynamic results.Methods The 30 patients who received Hancock Ⅱ Ultra aortic valve replacement at our hospital were matched 1 ∶1 with 30 patients who received Hancock Ⅱ on variables known to affect hemodynamic measurements:size of valve,age,sex,and body surface area.Early postoperative transthoracic echocardiography was performed in all patients.Results 3 months postoperatively,Hancock Ⅱ Ultra valves had significantly lower transvalular gradients,velocity,left ventricle mass index and larger effective orifice area.Compared with Hancock Ⅱ valves,in ≤22 mm group,Hancock Ⅱ Ultra valves had significantly lower transvalular velocity[ (2.26 ± 0.05 ) vs ( 2.57 ± 0.06 ),t =2.07,P ＜ 0.05 ],lower transvalular mean gradients [(11.4 ±1.3) vs (13.1 ±1.5),t =2.09,P＜0.05],higher effective orifice area[ (0.79 ±0.13)vs(0.71 ±0.02),t =2.06,P＜0.05],lower left ventricle mass index[ (119.1 ± 11.1)vs(133.2 ±16.4),t =2.67,P ＜0.05] and bigger left ventricle outflow tract (20.4 ±0.3 vs 18.9 ±0.2,t =2.23,P＜0.05).Conclusion The Hancock Ⅱ Ultra valve has more favorable early postoperative hemodynamics than the Hancock Ⅱ,especially for the small aortic ring patients.
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