Stoliński Jarosław, Plicner Dariusz, Mędrzyński Michal, Kapelak Bogusław
Przegl Lek. 2017;74(3):96-100.
To report the results of hybrid approach combining percutaneous coronary intervention (PCI) and minimally invasive aortic valve replacement through right anterior minithoracotomy (RT-AVR) for patients with aortic valve disease and coronary artery disease.
Retrospective analysis of 53 hybrid RT-AVR/ PCI procedures where RT-AVR was performed first in the operating room and followed immediately by PCI performed in the catheterization laboratory.
Predicted with Euro- SCORE II and observed hospital mortality was 8.7±2.9% and 1.9% respectively. Hospital and intensive care unit length of stay were 5.6±2.4 and 1.8±1.4 days respectively. Biological aortic valve prosthesis was implanted in 40 (75.5%) patients. PCI of LAD was performed in 5 patients (9.4%), of Dg in 10 (18.9%) patients, of Mg or Cx in 21 (39.6%) patients, of PDA or RCA in 25 (47.2%) patients. Two vessels and three vessels PCI were performed in 5 (9.4%) and 3 (5.7%) patients respectively. DES were used during PCI in 42 (79.2%) patients. Dual antiplatelet therapy with 75 mg of Aspirin and 75 mg of Clopidogrel started after RTAVR/ PCI. Complications occurred in 16 (30.2%) patients after hybrid RT-AVR/PCI procedure. Prolonged above 24 hours mechanical ventilation time was necessary in 3 patients (5.7%). Renal insufficiency occurred in 4 (7.5%), stroke in 1 (1.9%) patient. Pacemaker was implanted in 2 (3.8%) patients after surgery. Conversion to conventional surgery through median sternotomy was performed in 1 patient (1.9%), surgical revision due to postoperative bleeding in 2 patients (3.8%). No perioperative myocardial infarction and no mediastinitis was diagnosed after RT-AVR/PCI procedure. Postoperative chest blood drainage was 245.0±181.0 ml. Red blood cells transfusion was required in 10 (18.9%) patients.
The hybrid RT-AVR/PCI procedure for these high risk patients with aortic valve disease and coronary artery disease presented in our series favourable mortality results compared to predicted with EuroSCORE II mortality for conventional cardiac surgery.
报告经皮冠状动脉介入治疗（PCI）与经右前小切口微创主动脉瓣置换术（RT-AVR）相结合的杂交手术治疗主动脉瓣疾病合并冠状动脉疾病患者的结果。
回顾性分析53例杂交RT-AVR/PCI手术，其中RT-AVR在手术室先行，随后立即在导管室进行PCI。
根据欧洲心脏手术风险评估系统（Euro-SCORE）II预测，观察到的住院死亡率分别为8.7±2.9%和1.9%。住院时间和重症监护病房住院时间分别为5.6±2.4天和1.8±1.4天。40例（75.5%）患者植入了生物主动脉瓣膜假体。5例（9.4%）患者进行了左前降支（LAD）的PCI，10例（18.9%）患者进行了对角支（Dg）的PCI，21例（39.6%）患者进行了钝缘支或回旋支（Mg或Cx）的PCI，25例（47.2%）患者进行了动脉导管未闭或右冠状动脉（PDA或RCA）的PCI。5例（9.4%）患者进行了双支血管PCI，3例（5.7%）患者进行了三支血管PCI。42例（79.2%）患者在PCI期间使用了药物洗脱支架（DES）。RT-AVR/PCI术后开始使用75毫克阿司匹林和75毫克氯吡格雷进行双重抗血小板治疗。杂交RT-AVR/PCI术后16例（30.2%）患者发生并发症。3例（5.7%）患者需要机械通气时间延长超过24小时。4例（7.5%）患者出现肾功能不全，1例（1.9%）患者发生中风。2例（3.8%）患者术后植入了起搏器。1例（1.9%）患者转为经正中胸骨切开的传统手术，2例（3.8%）患者因术后出血进行了手术修复。RT-AVR/PCI术后未诊断出围手术期心肌梗死和纵隔炎。术后胸腔引流量为245.0±181.0毫升。
