van der Merwe Johan, Casselman Filip, Stockman Bernard, Van Praet Frank, Beelen Roel, Maene Lieven, Vermeulen Yvette, Degrieck Ivan
The Department of Cardiovascular and Thoracic Surgery, OLV-Clinic, Aalst, Belgium.
Ann Cardiothorac Surg. 2015 Mar;4(2):154-9. doi: 10.3978/j.issn.2225-319X.2015.01.08.
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.
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%.
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%.
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.
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。
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%。
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%。
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。