Aortic valve bypass for the high-risk patient with aortic stenosis
Aortic valve bypass for the high-risk patient with aortic stenosis
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DOI：
10.1016/j.athoracsur.2005.11.060
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发表时间：
2006-05-01
影响因子：
4.6
通讯作者：
Griffith, BP
中科院分区：
文献类型：
--
作者：
Gammie, JS;Brown, JW;Griffith, BP
背景心脏瓣膜病的经皮治疗的兴趣集中在主动脉瓣狭窄的高危患者。主动脉瓣旁路（心尖主动脉导管）手术是从左心室心尖到降主动脉构建包含生物瓣膜的血管移植物。我们已经进行了一项计划性的努力，在选定的高风险患者中进行主动脉瓣旁路手术作为传统主动脉瓣置换术的替代方案，现在报告我们最近的经验。2003年4月至2005年5月，14例主动脉瓣狭窄患者在两家机构接受了主动脉瓣旁路手术。所有选择接受主动脉瓣旁路手术的患者均被认为是传统主动脉瓣置换术的高风险患者。这些患者占同期接受单独主动脉瓣手术的所有243例患者中的14例（5.8%）。胸外科医师协会预测的平均手术死亡风险（11%）介于第90和第95年之间。14例患者中有12例既往接受过心脏手术，旁路移植术通畅。平均年龄为78岁。平均主动脉瓣面积为0.68 cm（2）。所有手术均在心脏不停跳下经左胸切口进行（阻断时间，0分钟）. 6例患者采用体外循环（中位体外循环时间，15分钟）。有2例围手术期死亡。术后平均住院时间为9天。发生2例非心源性晚期死亡。10名存活患者中有9名为功能I级，并独立生活。术后早期超声心动图证实主动脉瓣旁路功能良好，心室射血功能得到保留。主动脉瓣旁路手术治疗高危主动脉瓣狭窄患者是有希望的。避免胸骨切开术和心肺转流支持更广泛地应用于中度风险的主动脉瓣狭窄患者，并作为新型介入治疗研究的对照组。
Background. Interest in percutaneous therapy of heart valve disease has focused attention on the high- risk patient with aortic stenosis. Aortic valve bypass ( apicoaortic conduit) surgery is the construction of a vascular graft containing a bioprosthetic valve from the apex of the left ventricle to the descending thoracic aorta. We have undertaken a programmatic effort to perform aortic valve bypass surgery as an alternative to conventional aortic valve replacement in selected high-risk patients, and now report our recent experience.Methods. Between April 2003 and May 2005, 14 patients with aortic stenosis underwent aortic valve bypass surgery at two institutions. All patients selected for aortic valve bypass surgery were deemed to be at very high risk for conventional aortic valve replacement. These patients represented 14 ( 5.8%) of all 243 patients undergoing isolated aortic valve surgery during the same time period. Mean Society of Thoracic Surgeons predicted risk for operative mortality ( 11%) was between the 90th and 95th percentile.Results. Twelve of 14 patients had previous cardiac surgery with patent bypass grafts. Average age was 78 years. Mean aortic valve area was 0.68 cm(2). All operations were performed through a left thoracotomy on the beating heart ( cross- clamp time, 0 minutes). Cardiopulmonary bypass was used for 6 patients ( median cardiopulmonary bypass time, 15 minutes). There were 2 perioperative deaths. Median postoperative length of stay was 9 days. Two noncardiac late deaths occurred. Nine of 10 surviving patients are functional class I and are living independently. Early postoperative echocardiography confirms excellent aortic valve bypass function with preservation of ventricular ejection performance.Conclusions. Treatment of high- risk aortic stenosis patients with aortic valve bypass surgery is promising. Avoidance of sternotomy and cardiopulmonary bypass supports broader application to moderate- risk patients with aortic stenosis and as a control arm for studies of novel interventional therapies.