Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia.
Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia.
Ann Thorac Surg. 2022 Sep;114(3):720-726. doi: 10.1016/j.athoracsur.2021.08.036. Epub 2021 Sep 22.
Existing management challenges in selecting transcatheter vs surgical aortic valve replacement (SAVR) include bicuspid stenosis, low clinical risk, horizontal valve position, aortic insufficiency (AI), and need for concomitant procedures or mechanical valves. To address these gaps, we present our early experience with fully robotic-assisted aortic valve replacement (RAVR).
Between January 2020 and February 2021, 50 consecutive RAVR operations were performed using a 3- to 4-cm lateral mini-thoracotomy 3-port technique with transthoracic aortic clamping, similar to our robotic mitral platform. Conventional SAVR prostheses were implanted with interrupted braided sutures in all cases.
The 50 patients were a median age of 67.5 years, body mass index was 29 kg/m, calcified bicuspid disease was present in 28 (56%), and severe AI in 8 (16%). Ejection fraction was 0.55 ± 0.08 (mean ± SD), and The Society of Thoracic Surgeons predicted risk of mortality was 1.54% ± 0.7%. Mechanical prostheses were used in 16 of 50 (32%), and 7 required concomitant procedures, including Cox maze in 3, aortic root enlargement in 2, and left atrial appendage clipping, mitral repair, and left atrial myxoma excision in 1 each. Median times (minutes) were 166 for cardiopulmonary bypass, 117 for cross-clamp, 4 for valvectomy, 20 for annular sutures, and 31 for aortotomy closure. All times plateaued after the initial 5 cases. Extubation occurred in 42 of 50 patients (84%) in the operating room, and within 4 hours in the remaining 8 (16%). There was no 30-day operative mortality or stroke. All had 30-day echocardiography demonstrating no valvular or perivalvular abnormalities.
RAVR appears to have procedural safety and short-term outcomes to rival alternatives. Incremental experience may facilitate the safe performance of concomitant procedures as deemed necessary.
在经导管主动脉瓣置换术（TAVR）与外科主动脉瓣置换术（SAVR）的选择中，现有的管理挑战包括二叶式主动脉瓣狭窄、低临床风险、水平瓣位、主动脉瓣关闭不全（AI）以及需要同期手术或机械瓣。为了解决这些差距，我们展示了我们在全机器人辅助主动脉瓣置换术（RAVR）方面的早期经验。
在 2020 年 1 月至 2021 年 2 月期间，我们使用 3-4cm 的侧胸小切口 3 孔技术进行了 50 例连续的 RAVR 手术，类似于我们的机器人二尖瓣平台。所有病例均采用间断编织缝线植入传统的 SAVR 假体。
50 例患者的中位年龄为 67.5 岁，体重指数为 29kg/m，28 例（56%）存在钙化性二叶式疾病，8 例（16%）存在严重 AI。射血分数为 0.55±0.08（平均值±标准差），胸外科医师协会预测的死亡率为 1.54%±0.7%。50 例中有 16 例（32%）使用机械假体，7 例需要同期手术，包括 3 例 Cox 迷宫手术、2 例主动脉根部扩大术、1 例左心耳夹闭术、1 例二尖瓣修复术和 1 例左心房粘液瘤切除术。心肺转流时间中位数为 166 分钟，体外循环时间中位数为 117 分钟，瓣叶切除术时间中位数为 4 分钟，瓣环缝线时间中位数为 20 分钟，主动脉切开术关闭时间中位数为 31 分钟。所有时间在最初的 5 例后都趋于平稳。50 例中有 42 例（84%）在手术室拔管，其余 8 例（16%）在 4 小时内拔管。无 30 天手术死亡率或中风。所有患者均在 30 天内进行超声心动图检查，显示无瓣膜或瓣周异常。
RAVR 似乎具有与其他方法相当的程序安全性和短期结果。经验的增加可能有助于在必要时安全地进行同期手术。
