Aortic valve bypass surgery - Midterm clinical outcomes in a high-risk aortic stenosis population

[摘要] Background - Aortic valve bypass (AVB; apicoaortic conduit) surgery relieves aortic stenosis (AS) by shunting blood from the apex of the left ventricle to the descending thoracic aorta through a valved conduit. We have performed AVB surgery as an alternative to conventional aortic valve replacement for high-risk AS patients. Methods and Results - Between 2003 and 2007, 31 high-risk AS patients were treated with AVB surgery. Twenty-two patients (71%) were undergoing reoperation with patent coronary bypass grafts, and 5 (16%) had a porcelain ascending aorta. The average age was 81 years. Cardiopulmonary bypass was used for 19 of 31 patients (61%); the median duration of cardiopulmonary bypass was 19 minutes. Cross-clamp time for all patients was 0 minutes. Perioperative mortality was 13% (4 of 31 patients); no perioperative deaths occurred in the last 16 consecutive patients. One patient experienced a stroke related to intraoperative hypotension. No strokes have occurred during follow-up. Renal function was unchanged after AVB (preoperative creatinine, 1.3 +/- 0.5 mg/dL; postoperative creatinine, 1.2 +/- 0.5 mg/dL). The mean gradient across the native aortic valve decreased from 43.5 +/- 15 to 10.4 +/- 5.4 mm Hg. Echocardiographically determined conduit flow expressed as a percentage of total cardiac output was 72 +/- 12%. Conclusions - AVB surgery is an important therapeutic option for high-risk patients with symptomatic AS. Ventricular outflow is distributed in a predictable fashion between the conduit and the left ventricular outflow tract, and AVB surgery reliably relieves AS. Stroke and renal dysfunction were uncommon.

[效力级别]  Proceedings Paper

[关键词] CORONARY-ARTERY-BYPASS;CARDIAC-SURGERY;LATE MORTALITY;REPLACEMENT;MANAGEMENT;STENTLESS;SURVIVAL;TRIAL