Bociański Michał, Puślecki Mateusz, Olasińska-Wiśniewska Anna, Perek Bartłomiej, Stefaniak Sebastian, Buczkowski Piotr, Jemielity Marek
Department of Cardiac Surgery and Transplantology, Chair of Cardiac and Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland.
Department of Medical Rescue, Chair of Rescue Medicine, Poznan University of Medical Sciences, Poznan, Poland.
Kardiochir Torakochirurgia Pol. 2023 Jun;20(2):77-82. doi: 10.5114/kitp.2023.129542. Epub 2023 Jul 26.
The ministernotomy approach with sutureless aortic bioprosthesis may provide an attractive and safe option for aortic valve disease patients.
To assess the early and mid-term outcomes of minimally invasive aortic valve replacement (miniAVR) with sutureless vs. standard prostheses.
The study involved 76 consecutive patients (51 males and 25 females) with mean age of 63.2 years who were treated with miniAVR between 2015 and 2022. They were divided into 2 subgroups: group I ( = 40) subjects with sutureless bioprostheses and group II ( = 36) with standard prostheses implanted. Early and mid-term outcomes were evaluated. A probability of survival was estimated by means of the Kaplan-Meier method.
No conversion to complete sternotomy was necessary. The median (minimum; maximum) aorta cross clamping and cardio-pulmonary bypass times were 49 (27; 84) and 70 (40; 188) minutes in group I whereas 69 (50; 103) and 95 (69; 170) minutes in group II, respectively ( < 0.001). In-hospital mortality was 5.0% ( = 2) and 2.8% ( = 1) in group I vs. II, respectively (ns). Permanent ICD implantation was performed in 8 (20.0%) in group I and in 3 (8.3%) subjects in group II. In the discharge echocardiography, the function of all prostheses was correct. Five-year probability of survival was much lower in group I (0.75 ±0.10) than in group II (0.94 ±0.04). No wound infection or sternum instability was noted.
Intraoperative advantages of miniAVR procedures for aortic valve patients with sutureless bioprostheses do not translate directly into improved early and middle-term outcomes.
采用无缝合主动脉生物假体的小切口胸骨切开术方法可能为主动脉瓣疾病患者提供一种有吸引力且安全的选择。
评估使用无缝合假体与标准假体进行微创主动脉瓣置换术（miniAVR）的早期和中期结果。
该研究纳入了2015年至2022年间接受miniAVR治疗的76例连续患者（51例男性和25例女性），平均年龄63.2岁。他们被分为2个亚组：I组（n = 40）为植入无缝合生物假体的受试者，II组（n = 36）为植入标准假体的受试者。评估早期和中期结果。通过Kaplan-Meier方法估计生存概率。
无需转为完全胸骨切开术。I组主动脉交叉钳夹和体外循环时间的中位数（最小值；最大值）分别为49（27；84）分钟和70（40；188）分钟，而II组分别为69（50；103）分钟和95（69；170）分钟（P < 0.001）。I组和II组的住院死亡率分别为5.0%（n = 2）和2.8%（n = 1）（无统计学意义）。I组8例（20.0%）和II组3例（8.3%）受试者进行了永久性植入式心脏复律除颤器（ICD）植入。出院时超声心动图检查显示，所有假体功能正常。I组的5年生存概率（0.75±0.10）远低于II组（0.94±0.04）。未发现伤口感染或胸骨不稳定情况。
对于使用无缝合生物假体的主动脉瓣患者，miniAVR手术的术中优势并未直接转化为改善的早期和中期结果。
