LaPietra Angelo, Santana Orlando, Pineda Andrés M, Mihos Christos G, Lamelas Joseph
From the Divisions of *Cardiac Surgery, and †Cardiology, Columbia University, Mount Sinai Heart Institute, Miami Beach, FL USA.
Innovations (Phila). 2014 Sep-Oct;9(5):339-42; discussion 342. doi: 10.1097/IMI.0000000000000099.
Replacement of the aortic valve with concomitant replacement of the ascending aorta performed via a minimally invasive right anterior thoracotomy approach has not been reported. We evaluated the feasibility and safety of this procedure.
We retrospectively reviewed all minimally invasive aortic valve replacements (AVRs) with concomitant replacement of the ascending aorta performed at our institution between January 1, 2012, and December 30, 2012. The operative times, intensive care unit and hospital lengths of stay, postoperative outcomes, as well as mortality were analyzed.
A total of 20 consecutive patients who underwent minimally invasive AVR with concomitant replacement of the ascending aorta were identified. There were 16 men (80%), with a mean (SD) age of 61 (13) years. The mean (SD) left ventricular ejection fraction was 58% (8%). The aortic valve was bicuspid in 18 patients (80%), with 14 (70%) being stenotic. The median aortic cross-clamp and cardiopulmonary bypass times were 163 [interquartile range (IQR), 141-170] minutes and 291 (IQR, 177-215) minutes, respectively. Hypothermic circulatory arrest was required in 19 patients (95%), with a median hypothermic circulatory arrest time of 35 (IQR, 33-39.5) minutes. The median intensive care unit and hospital lengths of stay were 24 (IQR, 23-41) hours and 5 (IQR, 4-6) days, respectively. There were no strokes, reoperations for bleeding, or conversions to sternotomy. The 30-day mortality was zero.
Minimally invasive AVR with concomitant replacement of the ascending aorta, via a right anterior thoracotomy approach, can be performed with low morbidity and mortality.
经微创右前外侧开胸入路同期置换主动脉瓣和升主动脉的手术尚未见报道。我们评估了该手术的可行性和安全性。
回顾性分析2012年1月1日至2012年12月30日在我院行微创主动脉瓣置换术（AVR）同期置换升主动脉的所有患者。分析手术时间、重症监护病房（ICU）住院时间、住院时间、术后结局及死亡率。
共确定20例连续接受微创AVR同期置换升主动脉的患者。其中男性16例（80%），平均（标准差）年龄61（13）岁。平均（标准差）左心室射血分数为58%（8%）。18例（80%）患者主动脉瓣为二叶式，其中14例（70%）为狭窄型。主动脉阻断和体外循环时间中位数分别为163[四分位数间距（IQR），141 - 170]分钟和291（IQR，177 - 215）分钟。19例（95%）患者需要低温循环停搏，低温循环停搏时间中位数为35（IQR，33 - 39.5）分钟。ICU住院时间和住院时间中位数分别为24（IQR，23 - 41）小时和5（IQR，4 - 6）天。无中风、因出血再次手术或转为正中开胸手术。30天死亡率为零。
经右前外侧开胸入路行微创AVR同期置换升主动脉，可实现低发病率和死亡率。
