Division of Cardiothoracic Surgery, Joseph B. Whitehead Department of Surgery, Clinical Research Unit, Emory University School of Medicine, Atlanta, Georgia 30308, USA.
Ann Thorac Surg. 2011 Jan;91(1):131-6. doi: 10.1016/j.athoracsur.2010.10.074.
Elderly patients with aortic stenosis presenting for an aortic valve replacement with a hostile ascending aorta remain a challenging patient cohort. The purpose of this study was to assess outcomes after the use of an aortic valve bypass performed without cardiopulmonary bypass.
A retrospective review was performed on 21 high-risk patients who underwent primary, isolated aortic valve bypass from September 2004 to June 2009 at Emory Healthcare Hospitals. Aortic valve bypass was used for a porcelain aorta alone in 6 (28.6%) patients, previous coronary artery bypass grafting in 4 (19.0%), or both in 10 (47.6%). One patient (4.8%) was thought not to be a candidate for cardiopulmonary bypass secondary to a severe cirrhosis.
Mean age was 73.9±7.0 years (median, 75.0 years), and 15 patients (71.4%) were male. Mean New York Heart Association classification was 3.0±1.0 (median, 3.0), and preoperative ejection fraction was 0.460±0.163 (median, 0.500). Preoperative comorbidities included peripheral vascular disease (n=10; 47.6%), chronic lung disease (n=16; 76.2%), diabetes mellitus (n=10; 47.6%), and dialysis-dependence (n=2; 9.5%). Either an 18-mm (n=11; 52.4%) or 20-mm (n=10; 47.6%) conduit was used, with an interposed Freestyle 21 porcine root in all patients. All operations were performed without cardiopulmonary bypass. There were no intraoperative mortalities. The mean intensive care unit stay was 133.7±161.3 hours (median, 80.2 hours), and overall postoperative length of stay was 12.9±10.8 days (median, 9.0 days). In-hospital mortality occurred in 3 patients (14.3%). Mid-term follow-up shows an additional 4 patients died at a median follow-up of 1.3 years.
Aortic valve bypass without cardiopulmonary bypass is a feasible alternative for the treatment of severe aortic stenosis with acceptable short-term morbidity and minimal mortality in this extremely high-risk surgical population.
行主动脉瓣置换术的老年主动脉瓣狭窄患者，其升主动脉情况不佳，仍是极具挑战性的患者群体。本研究旨在评估在无体外循环情况下行主动脉瓣旁路手术的结果。
回顾性分析 2004 年 9 月至 2009 年 6 月期间在埃默里医疗保健医院行原发性孤立性主动脉瓣旁路手术的 21 例高危患者。6 例（28.6%）患者因瓷主动脉而行主动脉瓣旁路手术，4 例（19.0%）患者因既往冠状动脉旁路移植术而行主动脉瓣旁路手术，10 例（47.6%）患者因两者均而行主动脉瓣旁路手术。1 例（4.8%）患者因严重肝硬化而被认为不适合行体外循环。
平均年龄为 73.9±7.0 岁（中位数，75.0 岁），15 例（71.4%）为男性。平均纽约心脏协会心功能分级为 3.0±1.0（中位数，3.0），术前射血分数为 0.460±0.163（中位数，0.500）。术前合并症包括外周血管疾病（n=10；47.6%）、慢性肺部疾病（n=16；76.2%）、糖尿病（n=10；47.6%）和透析依赖（n=2；9.5%）。使用 18-mm（n=11；52.4%）或 20-mm（n=10；47.6%）移植物，所有患者均置入 Freestyle 21 猪主动脉根部。所有手术均在无体外循环的情况下进行。术中无死亡。重症监护病房平均停留时间为 133.7±161.3 小时（中位数，80.2 小时），术后总住院时间为 12.9±10.8 天（中位数，9.0 天）。3 例（14.3%）患者院内死亡。中期随访显示，在中位随访 1.3 年后，又有 4 例患者死亡。
对于高危外科患者群体，严重主动脉瓣狭窄患者在无体外循环的情况下行主动脉瓣旁路手术是一种可行的替代治疗方法，短期发病率可接受，死亡率低。
