Robinson Davida A, Johnson Carl A, Goodman Ariana M, Knight Peter A
1 Department of Surgery, University of Rochester, Rochester, NY, USA.
Innovations (Phila). 2019 Apr;14(2):159-167. doi: 10.1177/1556984519827685.
Aortic root enlargement may be necessary to implant adequately sized valves to avoid patient-prosthetic mismatch. Our objective was to assess the feasibility of annular enlargement during aortic valve replacement via a right anterior minithoracotomy.
Twelve consecutive patients undergoing elective minimally invasive aortic valve replacement requiring annular enlargement over a 2-year period were retrospectively reviewed. A right anterior minithoracotomy was performed in all patients. Cardiopulmonary bypass and aortic crossclamp times, hospital length of stay, postoperative complications, rate of reoperation, echocardiographic data, and mortality were analyzed.
Mean age was 66 years ± 14. Mean body mass index was 34 ± 7.8 kg/m. All patients had normal preoperative ejection fractions. Indications for aortic valve replacement were severe (3/12, 25%) or critical (9/12, 75%) aortic stenosis due to degenerative aortic valve disease (10/12, 83%) and congenitally bicuspid aortic valve (2/12, 17%). Cardiopulmonary bypass and aortic crossclamp times were 144.7 ± 14.7 minutes and 111.7 ± 10.6 minutes, respectively. The median postoperative length of stay was 4 days. Peak and mean aortic valve gradients on postreplacement intraoperative transesophageal echocardiography were 14.5 ± 9.4 mmHg and 7.2 ± 4.2 mmHg, respectively, with no perivalvular leak on intraoperative or follow-up transthoracic echocardiogram. Postoperative transthoracic echocardiography had peak and mean aortic valve gradients of 12.1 ± 6.9 mmHg and 6.3 ± 3.7 mmHg, respectively. There were no postoperative mortalities. Freedom from reoperation was 100%.
Annular enlargement performed during minimally invasive aortic valve replacement is feasible. Basic minimally invasive skills are recommended prior to instituting these more advanced techniques.
主动脉根部扩大对于植入尺寸合适的瓣膜以避免患者与人工瓣膜不匹配可能是必要的。我们的目的是评估经右前小切口在主动脉瓣置换术中进行瓣环扩大的可行性。
回顾性分析了连续12例在2年期间接受择期微创主动脉瓣置换术且需要进行瓣环扩大的患者。所有患者均行右前小切口手术。分析了体外循环和主动脉阻断时间、住院时间、术后并发症、再次手术率、超声心动图数据及死亡率。
平均年龄为66岁±14岁。平均体重指数为34±7.8kg/m²。所有患者术前射血分数均正常。主动脉瓣置换的指征为退行性主动脉瓣疾病（10/12，83%）和先天性二叶式主动脉瓣（2/12，17%）导致的重度（3/12，25%）或极重度（9/12，75%）主动脉狭窄。体外循环和主动脉阻断时间分别为144.7±14.7分钟和111.7±10.6分钟。术后中位住院时间为4天。置换后术中经食管超声心动图测得的主动脉瓣峰值和平均梯度分别为14.5±9.4mmHg和7.2±4.2mmHg，术中及随访经胸超声心动图均未发现瓣周漏。术后经胸超声心动图测得的主动脉瓣峰值和平均梯度分别为12.1±6.9mmHg和6.3±3.7mmHg。无术后死亡病例。再次手术率为100%。
在微创主动脉瓣置换术中进行瓣环扩大是可行的。在开展这些更先进的技术之前，建议先具备基本的微创技术。
