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Does additional aortic procedure carry a higher risk in patients undergoing aortic valve replacement?

作者信息

Kim Tae-Hun, Park Kay-Hyun, Yoo Jae Suk, Lee Jae Hang, Lim Cheong

机构信息

Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Korea.

出版信息

Korean J Thorac Cardiovasc Surg. 2012 Oct;45(5):295-300. doi: 10.5090/kjtcs.2012.45.5.295. Epub 2012 Oct 9.

DOI:10.5090/kjtcs.2012.45.5.295
PMID:23130302
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3487012/
Abstract

BACKGROUND

With growing attention to the aortopathy associated with aortic valve diseases, the number of candidates for accompanying ascending aorta and/or root replacement is increasing among the patients who require aortic valve replacement (AVR). However, such procedures have been considered more risky than AVR alone. This study aimed to compare the surgical outcome of isolated AVR and AVR combined with aortic procedures.

MATERIALS AND METHODS

A total of 86 patients who underwent elective AVR between 2004 and June 2010 were divided into two groups: complex AVR (n=50, AVR with ascending aorta replacement in 24 and the Bentall procedure in 26) and simple AVR (n=36). Preoperative characteristics, surgical data, intra- and postoperative allogenic blood transfusion requirement, the postoperative clinical course, and major complications were retrospectively reviewed and compared.

RESULTS

The preoperative mean logistic European System for Cardiac Operative Risk Evaluation (%) did not differ between the groups: 11.0±7.8% in the complex AVR group and 12.3±8.0% in the simple AVR group. Although complex AVR required longer cardiopulmonary bypass (152.4±52.6 minutes vs. 109.7±22.7 minutes, p=0.001), the quantity of allogenic blood products did not differ (13.4±14.7 units vs. 13.9±11.2 units). There was no mortality, mechanical circulatory support, stroke, or renal failure requiring hemodialysis/filtration. No difference was found in the incidence of bleeding (40% vs. 33.3%) which was defined as red blood cell transfusion ≥5 units, reoperation, or intentional delayed closure. The incidence of mediastinitis (2.0% vs. 0%), ventilator ≥24 hours (4.0% vs. 2.8%), atrial fibrillation (18.0% vs. 25.0%), mean intensive care unit stay (34.5 hours vs. 38.8 hours), and median hospital stay (8 days vs. 7 days) did not differ, either.

CONCLUSION

AVR combined with additional aortic or root replacement showed an excellent outcome and recovery course equivalent to that after isolated AVR.

摘要

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本文引用的文献

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Surgical experience of ascending aorta and aortic valve replacement in patient with calcified aorta.钙化性主动脉患者升主动脉及主动脉瓣置换术的手术经验
Korean J Thorac Cardiovasc Surg. 2012 Feb;45(1):24-9. doi: 10.5090/kjtcs.2012.45.1.24. Epub 2012 Feb 7.
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Effects of institutional volumes on operative outcomes for aortic root replacement in North America.北美主动脉根部置换术的机构容量对手术结果的影响。
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Indications for ascending aortic replacement size alone is not enough.仅依据升主动脉置换的尺寸作为指征是不够的。
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Thoracic aortic aneurysm clinically pertinent controversies and uncertainties.胸主动脉瘤的临床相关争议和不确定性。
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