Ramsaransing Krishan, Hindori Vikash, Kougioumtzoglou Athiná, Kaya Abdullah, Verbeek Eva
Cardiothoracic Surgery, Onze Lieve Vrouwe Gasthuis Ziekenhuis (OLVG) Amsterdam, Amsterdam, NLD.
Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, NLD.
Cureus. 2020 Oct 28;12(10):e11212. doi: 10.7759/cureus.11212.
Objectives Minimally invasive aortic valve replacement has the potential advantage of faster postoperative recovery compared to open procedures. Moreover, aortic valve replacement with a sutureless valve shortens procedure time. The aim of this study is to report early postoperative outcomes and one-year survival of patients undergoing sutureless aortic valve replacement with the Perceval S bioprosthesis (LivaNova, Milan, Italy) through a ministernotomy. Methods A total of 110 patients underwent sutureless aortic valve replacement in our center with the Perceval S bioprosthesis through a ministernotomy between February 2016 and March 2019. Data regarding preoperative and operative details, hospital stay, postoperative outcomes within 30 days after surgery, and one-year mortality were assessed. Results The mean cross-clamping time and extracorporeal circulation time were 54 ± 14 and 78 ± 21 minutes, respectively. No conversion to full median sternotomy was needed perioperatively. In-hospital mortality was 0.9%. Postoperative peak gradient was 13.3 mmHg; no major paravalvular leakage or valve migration occurred postoperatively. Postoperative complications consisted of one (0.9%) patient requiring full sternotomy for bleeding and two (1.8%) patients requiring re-ministernotomy due to acute tamponade. Pacemaker implantation was needed in four (3.6%) patients. Postoperative ischemic stroke rate and new-onset atrial fibrillation were 0.9% (n = 1) and 20% (n = 22), respectively, and one-year survival was 97.3%. Median intensive care unit and hospital stay were one and eight day(s), respectively. Conclusion Minimally invasive sutureless aortic valve replacement with the Perceval S bioprosthesis through a ministernotomy appears to be a safe procedure with good postoperative results and one-year survival. Further follow-up is needed to evaluate long-term outcomes.
目的 与开放性手术相比，微创主动脉瓣置换术具有术后恢复更快的潜在优势。此外，使用无缝合瓣膜进行主动脉瓣置换可缩短手术时间。本研究的目的是报告通过小切口胸骨切开术使用Perceval S生物假体（意大利米兰LivaNova公司）进行无缝合主动脉瓣置换术患者的术后早期结果和一年生存率。方法 2016年2月至2019年3月期间，共有110例患者在本中心通过小切口胸骨切开术使用Perceval S生物假体进行了无缝合主动脉瓣置换术。评估了术前和手术细节、住院时间、术后30天内的结果以及一年死亡率的数据。结果 平均主动脉阻断时间和体外循环时间分别为54±14分钟和78±21分钟。围手术期无需转为全胸骨正中切开术。住院死亡率为0.9%。术后峰值梯度为13.3 mmHg；术后未发生严重瓣周漏或瓣膜移位。术后并发症包括1例（0.9%）因出血需要进行全胸骨切开术的患者和2例（1.8%）因急性心脏压塞需要再次进行小切口胸骨切开术的患者。4例（3.6%）患者需要植入起搏器。术后缺血性卒中发生率和新发房颤发生率分别为0.9%（n = 1）和20%（n = 22），一年生存率为97.3%。重症监护病房和住院时间中位数分别为1天和8天。结论 通过小切口胸骨切开术使用Perceval S生物假体进行微创无缝合主动脉瓣置换术似乎是一种安全的手术，术后效果良好，一年生存率较高。需要进一步随访以评估长期结果。
