Mayr Benedikt, Firschke Christian, Erlebach Magdalena, Bleiziffer Sabine, Krane Markus, Joner Michael, Herold Ulf, Nöbauer Christian, Lange Rüdiger, Deutsch Marcus-André
Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.
Insure (Institute for Translational Cardiac Surgery), Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.
Interact Cardiovasc Thorac Surg. 2018 Jul 1;27(1):102-107. doi: 10.1093/icvts/ivy014.
Simultaneous surgical off-pump coronary revascularization and transcatheter aortic valve implantation (TAVI) as a hybrid procedure may be a therapeutic option for patients with a TAVI indication who are not suitable for percutaneous coronary intervention and for patients who have an indication for combined surgical aortic valve implantation and coronary artery bypass grafting but present with a porcelain aorta. Early outcomes of these patients are analysed in this study.
From February 2011 to April 2017, hybrid TAVI/off-pump coronary artery bypass (OPCAB) was performed in 12 (60%) patients, hybrid TAVI/minimally invasive direct coronary artery bypass in 6 (30%) patients and staged TAVI/OPCAB in 2 (10%) patients. Endpoints of this study were 30-day mortality, device success and postoperative adverse events as defined by the updated Valve Academic Research Consortium (VARC-2).
The median age at the time of surgery was 77 years [interquartile range (IQR), 70-81] with a median logistic EuroSCORE and Society of Thoracic Surgeons' Predicted Risk score of 16.1% (IQR, 9.3-28.1) and 3.9% (IQR, 2.2-5.6), respectively. The median Synergy between PCI with Taxus and Cardiac Surgery score was 16.5 (IQR, 9.8-22.8). TAVI implantation routes were transaortic in 9 (45%) patients, transapical and transfemoral in 5 (25%) patients each and trans-subclavian in 1 (5%) patient. Complete myocardial revascularization was achieved in 75% of patients. Device success rate was 100%. Paravalvular aortic regurgitation did not exceed mild in any patient. Stroke/transient ischaemic attack, vascular complications and myocardial infarction were not observed. Re-exploration for bleeding was required in 1 (5%) patient. Thirty-day mortality was 0%.
Hybrid OPCAB/MIDCAB and TAVI prove to be a safe and effective alternative treatment option in selected higher risk patients.
同期进行非体外循环冠状动脉血运重建术和经导管主动脉瓣植入术（TAVI）作为一种杂交手术，对于有TAVI指征但不适合经皮冠状动脉介入治疗的患者，以及有联合外科主动脉瓣植入术和冠状动脉旁路移植术指征但存在瓷化主动脉的患者，可能是一种治疗选择。本研究分析了这些患者的早期结局。
2011年2月至2017年4月，12例（60%）患者接受了杂交TAVI/非体外循环冠状动脉旁路移植术（OPCAB），6例（30%）患者接受了杂交TAVI/微创直接冠状动脉旁路移植术，2例（10%）患者接受了分期TAVI/OPCAB。本研究的终点为30天死亡率、器械成功率和术后不良事件，不良事件定义参照更新后的瓣膜学术研究联盟（VARC-2）标准。
手术时患者的中位年龄为77岁[四分位间距（IQR），70 - 81岁]，中位逻辑欧洲心脏手术风险评估系统（EuroSCORE）和胸外科医师协会预测风险评分分别为16.1%（IQR，9.3 - 28.1）和3.9%（IQR，2.2 - 5.6）。紫杉醇药物洗脱支架与心脏手术协同评分（SYNTAX）的中位数为16.5（IQR，9.8 - 22.8）。TAVI植入途径为经主动脉9例（45%），经心尖和经股动脉各5例（25%），经锁骨下动脉1例（5%）。75%的患者实现了完全心肌血运重建。器械成功率为100%。所有患者的瓣周主动脉瓣反流均未超过轻度。未观察到卒中/短暂性脑缺血发作、血管并发症和心肌梗死。1例（5%）患者因出血需要再次手术探查。30天死亡率为0%。
对于部分高风险患者，杂交OPCAB/MIDCAB和TAVI被证明是一种安全有效的替代治疗选择。
