Transapical Aortic Valve Implantation: Therapy of Choice for Patients With Aortic Stenosis and Porcelain Aorta?
Transapical Aortic Valve Implantation: Therapy of Choice for Patients With Aortic Stenosis and Porcelain Aorta?
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DOI：
10.1016/j.athoracsur.2010.06.080
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发表时间：
2010-11-01
影响因子：
4.6
通讯作者：
Walther, Thomas
中科院分区：
文献类型：
--
作者：
Kempfert, Joerg;Van Linden, Arnaud;Walther, Thomas
背景陶瓷主动脉患者的传统主动脉瓣置换术在技术上具有挑战性，并且与高卒中率和死亡率相关。瓷化主动脉有时甚至被视为手术禁忌症。微创非体外循环经心尖主动脉瓣植入术可能是治疗需要主动脉瓣置换的老年瓷化主动脉患者的最佳策略。29例主动脉重度狭窄和瓷化主动脉患者接受了经心尖主动脉瓣植入术。平均年龄为79 ± 7.8岁（范围：64 - 93岁），其中65.5%为女性。Logistic EuroSCORE和胸外科医师协会评分分别为37.7% +/- 18.1%和12.8% +/-2.2%。外周血管疾病（41.4%）和颈动脉狭窄（58.6%）是常见的，17.2%的患者既往发生过卒中。大多数患者为再次透析病例（51.2%），10.3%的患者依赖长期血液透析。在所有患者中，13.8%的患者术中发现陶瓷主动脉导致通过胸骨切开术进行传统主动脉瓣置换术的尝试失败。所有瓣膜均成功植入，无栓塞或主动脉夹层。所有手术均主要在体外循环下进行，但4例患者因并发症需要二次心肺转流。中位手术时间为80分钟，中位重症监护室停留时间为1天。仅1例患者发生卒中。30天死亡率为17.2%。轻度瓣周漏31.0%，轻中度返流1例。经心尖主动脉瓣植入术是治疗需要主动脉瓣置换术的瓷化主动脉老年患者的一种有前途的方法。它与可接受的结局和低卒中率相关。
Background. Conventional aortic valve replacement can be technically challenging in patients with porcelain aorta and is associated with a high rate of stroke and mortality. Porcelain aorta is even sometimes seen as contraindication for surgery. Minimally invasive off-pump transapical aortic valve implantation may be an optimal strategy to treat elderly patients with porcelain aorta requiring aortic valve replacement.Methods. Twenty-nine patients with severe aortic stenosis and porcelain aorta underwent transapical aortic valve implantation. Mean age was 79 +/- 7.8 years (range, 64 to 93 years), with 65.5% female. Logistic EuroSCORE and the Society of Thoracic Surgeons score were 37.7% +/- 18.1% and 12.8% +/- 2.2%, respectively. Peripheral vascular disease (41.4%) and carotid artery stenosis (58.6%) were frequent, and 17.2% of patients had experienced a stroke previously. The majority of patients were redo cases (51.2%), and 10.3% were dependent on chronic hemodialysis. In 13.8% of all patients, intraoperatively detected porcelain aorta caused an attempt at conventional aortic valve replacement by means of sternotomy to be aborted.Results. All valves were implanted successfully without embolization or aortic dissection. All procedures were primarily performed off-pump, but 4 patients required secondary cardiopulmonary bypass as a result of complications. Median procedure time was 80 minutes, and median intensive care unit stay was 1 day. Stroke occurred in 1 patient only. Thirty-day mortality was 17.2%. Mild paravalvular leak was seen in 31.0%, and mild to moderate regurgitation occurred in 1 patient.Conclusions. Transapical aortic valve implantation is a promising approach to treat elderly patients with porcelain aorta requiring aortic valve replacement. It is associated with acceptable outcome and low stroke rates.