Sahin Ayhan, Müggler Oliver, Sromicki Juri, Caliskan Etem, Reser Diana, Emmert Maximilian Y, Alkadhi Hatem, Maisano Francesco, Falk Volkmar, Holubec Tomas
Division of Cardiovascular Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Eur J Cardiothorac Surg. 2016 Dec;50(6):1172-1178. doi: 10.1093/ejcts/ezw167. Epub 2016 May 26.
The aim of this study was to analyse long-term results of aortic root replacement with the Shelhigh® NR-2000C conduit.
From January 2001 to October 2005, 63 patients with a median age of 62 years underwent aortic root replacement with a Shelhigh® conduit. Aneurysm (27%), aortic valve endocarditis (30%) and acute type A aortic dissection (33%) were the predominant indications for the surgery. Fifty-four patients (86%) were entered in the follow-up study with the end-points of death, aortic root-related reoperation and endocarditis.
The overall 30-day mortality rate was 8% (n = 5). The median follow-up was 9.5 years (range 0-14.2 years). In total, 13 (24%) deaths occurred during follow-up; of these, 4 were directly conduit-related. The overall estimated survival rates at 1, 5 and 10 years were 85 ± 5, 79 ± 6 and 71 ± 7%, respectively. Reoperation was necessary in 10 (19%) patients due to endocarditis (n = 5), aortic stenosis (n = 3), pseudoaneurysm due to detachment of the right coronary artery (n = 1) and detachment of the non-coronary leaflet (n = 1). The overall estimated rate of freedom from aortic root-related reoperation at 1, 5 and 10 years was 83 ± 5, 79 ± 6 and 64 ± 7%, respectively. Endocarditis of the prosthesis was reported in 9 (17%) patients; of whom, 5 patients required reoperation and 4 were treated medically. In 1 patient with endocarditis, a stroke was reported due to a thromboembolic event.
The first long-term follow-up after aortic root replacement with the Shelhigh® BioConduit revealed a relatively high rate of death and very high rate of reoperations due to endocarditis, aorto-ventricular disconnection and structural valve failure. This may be potentially connected to the nature of the implanted valved conduit.
本研究旨在分析使用Shelhigh® NR - 2000C导管进行主动脉根部置换的长期结果。
2001年1月至2005年10月，63例中位年龄为62岁的患者接受了使用Shelhigh®导管的主动脉根部置换术。动脉瘤（27%）、主动脉瓣心内膜炎（30%）和急性A型主动脉夹层（33%）是该手术的主要适应证。54例患者（86%）进入随访研究，终点为死亡、主动脉根部相关再次手术和心内膜炎。
30天总体死亡率为8%（n = 5）。中位随访时间为9.5年（范围0 - 14.2年）。随访期间共发生13例（24%）死亡；其中4例与导管直接相关。1年、5年和10年的总体估计生存率分别为85±5%、79±6%和71±7%。10例（19%）患者因心内膜炎（n = 5）、主动脉狭窄（n = 3）、右冠状动脉脱离导致假性动脉瘤（n = 1）和无冠瓣叶脱离（n = 1）而需要再次手术。1年、5年和10年主动脉根部相关再次手术的总体估计无事件发生率分别为83±5%、79±6%和64±7%。9例（17%）患者报告了人工瓣膜心内膜炎；其中，5例患者需要再次手术，4例接受药物治疗。1例心内膜炎患者因血栓栓塞事件发生中风。
使用Shelhigh®生物导管进行主动脉根部置换后的首次长期随访显示，由于心内膜炎、主动脉心室脱节和结构性瓣膜故障，死亡率相对较高，再次手术率非常高。这可能与植入的带瓣导管的性质潜在相关。
