Maroto Luis C, Carnero Manuel, Cobiella Javier, García Mónica, Vilacosta Isidre, Reguillo Fernando, Villagrán Enrique, Olmos Carmen
Department of Cardiac Surgery, Cardiovascular Institute, Clínico San Carlos Hospital, Madrid, Spain.
Department of Cardiology, Cardiovascular Institute, Clínico San Carlos Hospital, Madrid, Spain.
J Card Surg. 2018 Jun;33(6):330-336. doi: 10.1111/jocs.13710. Epub 2018 May 3.
The replacement of a failed composite valve graft is technically more demanding and is associated with increased morbidity and mortality. We present our technique and outcomes for reoperations for composite graft failures.
Between September 2011 and June 2017, 14 patients underwent a redo composite graft replacement. Twelve patients (85.7%) were male, and mean age was 58.4 years ± 12 standard deviation (SD). One patient had two previous root replacements. Indications for reoperation were endocarditis (8), aortic pseudoaneurysm (3), and aortic prosthesis thrombosis (3). Mean logistic EuroSCORE and EuroSCORE II were 30.8% and 14.7%, respectively.
A mechanical composite graft was used in 12 patients and biological composite grafts were used in two patients. Hospital mortality was 14.3% (n = 2). One patient (7.1%) required reoperation for bleeding, One patient (7.1%) had mechanical ventilation >24 h, and four patients (28.6%) required implantation of a permanent pacemaker. Median intensive care unit and hospital stays were 3 days (interquartile range [IQR] 1-5) and 10 days (IQR 6.5-38.5). One patient experienced recurrent prosthetic valve endocarditis 14 months after operation. On follow-up, 11 of 12 survivors were in New York Heart Association class I or II. Survival at 3 years was 85.7% ± 9.4% SD.
Composite valve graft replacement can be performed with acceptable morbidity and mortality with good mid-term survival.
更换失效的复合瓣膜移植物在技术上要求更高，且与发病率和死亡率增加相关。我们介绍了复合移植物失效再次手术的技术及结果。
2011年9月至2017年6月期间，14例患者接受了再次复合移植物置换术。12例患者（85.7%）为男性，平均年龄58.4岁±12标准差（SD）。1例患者曾接受过两次根部置换。再次手术的指征为心内膜炎（8例）、主动脉假性动脉瘤（3例）和主动脉人工血管血栓形成（3例）。平均逻辑欧洲心脏手术风险评估系统（EuroSCORE）和欧洲心脏手术风险评估系统II（EuroSCORE II）分别为30.8%和14.7%。
12例患者使用了机械复合移植物，2例患者使用了生物复合移植物。医院死亡率为14.3%（n = 2）。1例患者（7.1%）因出血需要再次手术，1例患者（7.1%）机械通气时间>24小时，4例患者（28.6%）需要植入永久起搏器。重症监护病房和住院时间的中位数分别为3天（四分位间距[IQR] 1 - 5）和10天（IQR 6.5 - 38.5）。1例患者术后14个月发生人工瓣膜心内膜炎复发。随访时，12例幸存者中有11例纽约心脏协会心功能分级为I级或II级。3年生存率为85.7%±9.4% SD。
复合瓣膜移植物置换术可在可接受的发病率和死亡率情况下进行，中期生存率良好。
