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微创原发性主动脉瓣手术:奥尔斯特医院的经验

Minimally invasive primary aortic valve surgery: the OLV Aalst experience.

作者信息

van der Merwe Johan, Casselman Filip, Stockman Bernard, Van Praet Frank, Beelen Roel, Maene Lieven, Vermeulen Yvette, Degrieck Ivan

机构信息

The Department of Cardiovascular and Thoracic Surgery, OLV-Clinic, Aalst, Belgium.

出版信息

Ann Cardiothorac Surg. 2015 Mar;4(2):154-9. doi: 10.3978/j.issn.2225-319X.2015.01.08.

Abstract

BACKGROUND

The purpose of this study was to evaluate our in-hospital outcomes with primary J-sternotomy aortic valve surgery since the initiation of our program in 1997.

METHODS

Between October 1(st) 1997 and August 31(st) 2014, 768 patients (mean age: 69.1±11.2 years, 46.6% females, 15.6% aged greater than 80 years) underwent primary JS-AVS. Additional risk factors included diabetes mellitus (n=98, 12.2%), peripheral vascular disease (n=42, 5.5%) and body mass index greater than 30 (n=144, 18.8%). The mean logistical EuroSCORE I was 5.46%±4.5%.

RESULTS

Aortic valve replacement and repair were performed in 758 (98.7%) and 10 (1.3%) patients respectively, for isolated valve stenosis (n=472, 61.8%), incompetence (n=56, 7.3%) and mixed valve disease (n=236, 30.9%). Valve pathology included sclerosis (n=516, 67.2%), rheumatic disease (n=110, 14.3%) and endocarditis (n=10, 1.3%). Reasons for conversion to full sternotomy (n=23, 3.0%) included porcelain ascending aorta (n=3, 0.4%), inadequate visualization (n=2, 0.3%) and intra-operative complications (n=18, 2.3%). Mean length of hospital stay was 11.0±7.4 days. Morbidity included stroke (n=15, 2.0%), revision or re-exploration (n=52, 6.8%), atrial fibrillation (n=201, 26.2%) and sternitis (n=5, 0.7%). In-hospital mortality was 1.6% (n=12). Overall survival at 30 days was 98.0%.

CONCLUSIONS

JS-AVS is safe and is our routine approach for isolated aortic valve disease. Procedure related mortality is lower than predicted, conversion rates limited and significant morbidity minimal.

摘要

背景

本研究的目的是评估自1997年我们开展该项目以来,初次经J形胸骨切开术进行主动脉瓣手术的院内结局。

方法

在1997年10月1日至2014年8月31日期间,768例患者(平均年龄:69.1±11.2岁,女性占46.6%,15.6%年龄大于80岁)接受了初次经J形胸骨切开术主动脉瓣手术(JS-AVS)。其他危险因素包括糖尿病(n = 98,12.2%)、外周血管疾病(n = 42,5.5%)和体重指数大于30(n = 144,18.8%)。平均逻辑欧洲心脏手术风险评估系统(EuroSCORE)I评分为5.46%±4.5%。

结果

分别有758例(98.7%)和10例(1.3%)患者进行了主动脉瓣置换和修复,病因包括单纯瓣膜狭窄(n = 472,61.8%)、关闭不全(n = 56,7.3%)和混合性瓣膜疾病(n = 236,30.9%)。瓣膜病理包括硬化(n = 516,67.2%)、风湿性疾病(n = 110,14.3%)和心内膜炎(n = 10,1.3%)。转为全胸骨切开术的原因(n = 23,3.0%)包括升主动脉瓷化(n = 3,0.4%)、视野不佳(n = 2,0.3%)和术中并发症(n = 18,2.3%)。平均住院时间为11.0±7.4天。并发症包括中风(n = 15,2.0%)、再次手术或重新探查(n = 52,6.8%)、心房颤动(n = 201,26.2%)和胸骨炎(n = 5,0.7%)。院内死亡率为1.6%(n = 12)。30天总体生存率为98.0%。

结论

经J形胸骨切开术主动脉瓣手术是安全的,是我们治疗单纯主动脉瓣疾病的常规方法。手术相关死亡率低于预期,转换率有限,严重并发症极少。

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