Ram Eilon, Amunts Sergei, Zuroff Elchanan, Peled Yael, Kogan Alexander, Raanani Ehud, Sternik Leonid
Department of Cardiac Surgery, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Department of Cardiology, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
J Card Surg. 2020 Jul;35(7):1452-1457. doi: 10.1111/jocs.14601. Epub 2020 May 3.
Until early into the 21st century, the only therapeutic option for aortic valve (AV) stenosis was surgical aortic valve replacement (AVR), but this changed with the introduction of transcatheter aortic valve implantation (TAVI). Our objective was to present the results of surgical AVR performed in low-risk patients in the era of TAVI, in a large tertiary medical center.
Data from low surgical risk patients (defined as Euroscore < 5) greater than 60 years of age, who underwent isolated AVR surgery between 2004 and 2018, were obtained from our departmental database. Of the 313 study patients, 110 (35%) underwent isolated AVR before 2010 (early period) and 203 patients (65%) underwent the same procedure from 2010 onward (late period).
Mean age was 67 ± 5 years and 182 (58%) were male. Fifty-six patients (18%) had a unicuspid or bicuspid AV. Patient characteristics were similar between the early and late periods. There was no in-hospital or 30-day mortality throughout the entire cohort, with one case (0.3%) of postoperative stroke. Permanent pacemaker implantation was required in 2.2% (N = 7). Patients in the early period required significantly more re-exploration due to bleeding/tamponade (8.2% vs 1.5%; P = .008). Long-term mortality (1, 3, and 5 years) was higher in the early compared with the late period (2.7% vs 1%, 7.3% vs 3%, and 15.5% vs 3.4%, respectively; log-rank P = .005).
Surgical AVR provides excellent short- and long-term results with low morbidity and mortality in low surgical risk patients. While patient characteristics did not change dramatically over the years, the long-term results were encouraging.
直到21世纪初，主动脉瓣（AV）狭窄的唯一治疗选择是外科主动脉瓣置换术（AVR），但经导管主动脉瓣植入术（TAVI）的引入改变了这一状况。我们的目的是在一家大型三级医疗中心展示在TAVI时代低风险患者接受外科AVR的结果。
从我们科室的数据库中获取2004年至2018年间年龄大于60岁、手术风险低（定义为欧洲心脏手术风险评估系统评分<5）且接受单纯AVR手术患者的数据。在313例研究患者中，110例（35%）在2010年前（早期）接受单纯AVR，203例（65%）从2010年起（晚期）接受相同手术。
平均年龄为67±5岁，182例（58%）为男性。56例患者（18%）有单叶或二叶主动脉瓣。早期和晚期患者特征相似。整个队列中无住院或30天死亡率，有1例（0.3%）术后中风。2.2%（N = 7）的患者需要植入永久性起搏器。早期患者因出血/心包填塞需要再次手术的比例显著更高（8.2%对1.5%；P = 0.008）。早期的长期死亡率（1年、3年和5年）高于晚期（分别为2.7%对1%、7.3%对3%和15.5%对3.4%；对数秩检验P = 0.005）。
外科AVR在低手术风险患者中提供了优异的短期和长期结果，发病率和死亡率低。虽然多年来患者特征没有显著变化，但长期结果令人鼓舞。
