Walther Thomas, Falk Volkmar, Borger Michael A, Dewey Todd, Wimmer-Greinecker Gerhard, Schuler Gerhard, Mack Michael, Mohr Friedrich W
Department of Cardiac Surgery, Heartcenter, University Leipzig, Leipzig, Germany.
Eur J Cardiothorac Surg. 2007 Jan;31(1):9-15. doi: 10.1016/j.ejcts.2006.10.034. Epub 2006 Nov 9.
To evaluate the feasibility of minimally invasive transapical beating heart aortic valve implantation (TAP-AVI) for high-risk patients with aortic stenosis.
TAP-AVI was performed via a small anterolateral minithoracotomy with or without femoral extracorporeal circulation (ECC) on the beating heart. A pericardial xenograft fixed within a stainless steel, balloon expandable stent (Cribier-Edwards, Edwards Lifesciences, Irvine, CA, USA) was used. Thirty consecutive patients (82 +/- 5.1 years, 21 (70%) female) were operated from 02/06 until 09/06 at one center using fluoroscopic and echocardiographic visualization. Average EuroSCORE predicted risk for mortality was 27 +/- 12%.
Valve positioning was successful in 29 patients and one required early conversion to full sternotomy. Implantation (8 mm x 23 mm and 22 mm x 26 mm valves) was performed on the beating heart during brief periods of rapid ventricular pacing. ECC was applied in 13 patients. Neither coronary artery obstruction nor migration of the prosthesis was observed and all valves displayed good hemodynamic function. Echocardiography revealed minor paravalvular leakage in 14 patients (trace in three, mild in nine and moderate in two). Three patients (10%) died, one on postoperative day (POD) three secondary to preoperative global myocardial failure and two on POD 18 and 86 due to abdominal complications.
Minimally invasive beating heart TAP-AVI is feasible. Initial results are encouraging in view of the high-risk profile of the patients. Long-term studies as well as randomized protocols are required.
评估经心尖微创跳动心脏主动脉瓣植入术（TAP - AVI）用于高危主动脉瓣狭窄患者的可行性。
通过小的前外侧开胸术在跳动心脏上进行TAP - AVI，可使用或不使用股动脉体外循环（ECC）。使用固定在不锈钢球囊可扩张支架（美国加利福尼亚州尔湾市爱德华兹生命科学公司的Cribier - Edwards）内的心包异种移植物。从2006年2月至2006年9月，在一个中心对30例连续患者（年龄82±5.1岁，21例（70%）为女性）进行手术，采用荧光透视和超声心动图可视化。欧洲心脏手术风险评估系统（EuroSCORE）预测的平均死亡率风险为27±12%。
29例患者瓣膜定位成功，1例需要早期转为全胸骨切开术。在快速心室起搏的短时间内，于跳动心脏上植入瓣膜（8毫米×23毫米和22毫米×26毫米瓣膜）。13例患者应用了ECC。未观察到冠状动脉阻塞或假体移位，所有瓣膜均显示出良好的血流动力学功能。超声心动图显示14例患者有轻微瓣周漏（3例微量，9例轻度，2例中度）。3例患者（10%）死亡，1例于术后第3天因术前全心功能衰竭死亡，2例分别于术后第18天和第86天因腹部并发症死亡。
微创跳动心脏TAP - AVI是可行的。鉴于患者的高危特征，初步结果令人鼓舞。需要进行长期研究以及随机对照试验。
