The Thoracic and cardiovascular surgeon · 2007
Should minimally invasive aortic valve replacement be restricted to primary interventions?
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Bakir I, Casselman F P, De Geest R, Wellens F, Degrieck I, Van Praet F, Vermeulen Y, Vanermen H
Аннотация
BACKGROUND: The role of minimally invasive aortic valve replacement in cardiac reoperations has not yet been defined. The purpose of this study is to report our experience with this technique.
METHODS: Nineteen consecutive patients underwent aortic valve replacement via J-sternotomy as a reoperative cardiac procedure between 1999 and 2005. The mean age was 73.6 +/- 11.4 years. Previous cardiac operations included 12 (63.2 %) coronary artery bypass graftings, 6 (31.5 %) aortic valve replacements and 1 (5.2 %) mitral valve replacement. Mean follow-up was 23.6 +/- 19.7 months. The medical records were retrospectively analyzed.
RESULTS: All procedures were successful. Mean aortic cross-clamping time and cardiopulmonary bypass time were 87.4 +/- 32.7 and 133.1 +/- 54.4 minutes, respectively. Cannulation sites were: ascending aorta (52.6 %), femoral artery (47.4 %), femoral vein (94.8 %) and right atrium (5.2 %). Myocardial protection was obtained by selective coronary osteal cold crystalloid cardioplegia and systemic cooling (mean 26.2 +/- 4 degrees C). Average intubation time was 1.5 +/- 1.4 days. Mean intensive care unit stay and postoperative hospital stay was 2.9 +/- 2.6 and 12.9 +/- 5.7 days, respectively. Median chest tube output was 550 ml. There were 4 revisions for bleeding. There were 2 late deaths and one non-incision related hospital death (5 %). This patient, who was already being treated for chronic dialysis, died on day 22 due to a cerebrovascular accident.
CONCLUSIONS: Minimally invasive aortic valve replacement is feasible as a reoperative procedure. Its major advantage is avoidance of cardiac reexposure with potential damage to coronary grafts. We think this technique deserves more widespread application.
METHODS: Nineteen consecutive patients underwent aortic valve replacement via J-sternotomy as a reoperative cardiac procedure between 1999 and 2005. The mean age was 73.6 +/- 11.4 years. Previous cardiac operations included 12 (63.2 %) coronary artery bypass graftings, 6 (31.5 %) aortic valve replacements and 1 (5.2 %) mitral valve replacement. Mean follow-up was 23.6 +/- 19.7 months. The medical records were retrospectively analyzed.
RESULTS: All procedures were successful. Mean aortic cross-clamping time and cardiopulmonary bypass time were 87.4 +/- 32.7 and 133.1 +/- 54.4 minutes, respectively. Cannulation sites were: ascending aorta (52.6 %), femoral artery (47.4 %), femoral vein (94.8 %) and right atrium (5.2 %). Myocardial protection was obtained by selective coronary osteal cold crystalloid cardioplegia and systemic cooling (mean 26.2 +/- 4 degrees C). Average intubation time was 1.5 +/- 1.4 days. Mean intensive care unit stay and postoperative hospital stay was 2.9 +/- 2.6 and 12.9 +/- 5.7 days, respectively. Median chest tube output was 550 ml. There were 4 revisions for bleeding. There were 2 late deaths and one non-incision related hospital death (5 %). This patient, who was already being treated for chronic dialysis, died on day 22 due to a cerebrovascular accident.
CONCLUSIONS: Minimally invasive aortic valve replacement is feasible as a reoperative procedure. Its major advantage is avoidance of cardiac reexposure with potential damage to coronary grafts. We think this technique deserves more widespread application.