Journal of Chest Surgery

  • 제51권1호
  • /
  • Pages.1-7
  • /
  • 2018
  • /
  • 2765-1606(pISSN)
  • /
  • 2765-1614(eISSN)
대한심장혈관흉부외과학회 (The Korean Society for Thoracic and Cardiovascular Surgery)
권호 표지
DOI QR코드

DOI QR Code

Early Clinical Experience with Sutureless Aortic Valve Replacement for Severe Aortic Stenosis

  • Kim, Do Jung (Department of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Kim, Hyo-Hyun (Department of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Lee, Shin-Young (Department of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Lee, Sak (Department of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Chang, Byung-Chul (Department of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine)
  • 투고 : 2017.05.25
  • 심사 : 2017.07.11
  • 발행 : 2018.02.05
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Background: Sutureless aortic valve replacement (SU-AVR) has been developed as an alternative surgical treatment for patients with symptomatic severe aortic stenosis (AS). The aim of this study was to evaluate the clinical outcomes of SU-AVR through an assessment of hemodynamic performance and safety. Methods: From December 2014 to June 2016, a total of 12 consecutive patients with severe AS underwent SU-AVR. The endpoints were overall survival and valve-related complications (paravalvular leakage, valve thrombosis, migration, endocarditis, and permanent pacemaker implantation). The mean follow-up duration was $18.1{\pm}8.6months$. Results: The mean age of the patients was $77.1{\pm}5.8years$ and their mean Society of Thoracic Surgeons score was $9.2{\pm}17.7$. The mean cardiopulmonary bypass and aortic cross-clamp times were $94.5{\pm}37.3$ minutes and $54.9{\pm}12.5minutes$, respectively. Follow-up echocardiography showed good prosthesis function with low transvalvular pressure gradients (mean, $13.9{\pm}8.6mm\;Hg$ and peak, $27.2{\pm}15.0mm\;Hg$) at a mean of $9.9{\pm}4.2months$. No cases of primary paravalvular leakage, valve thrombosis, migration, or endocarditis were reported. A new permanent pacemaker was implanted in 1 patient (8.3%). The 1-year overall survival rate was $83.3%{\pm}10.8%$. Conclusion: Our initial experience with SU-AVR demonstrated excellent early clinical outcomes with good hemodynamic results. However, there was a high incidence of permanent pacemaker implantation compared to the rate for conventional AVR, which is a problem that should be solved.

키워드

참고문헌

  1. Lund O. Preoperative risk evaluation and stratification of long-term survival after valve replacement for aortic stenosis: reasons for earlier operative intervention. Circulation 1990;82:124-39. https://doi.org/10.1161/01.CIR.82.1.124
  2. Vahanian A, Alfieri O, Andreotti F, et al. Guidelines on the management of valvular heart disease (version 2012): the Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur J Cardiothorac Surg 2012;42:S1-44. https://doi.org/10.1093/ejcts/ezs455
  3. Santarpino G, Pfeiffer S, Jessl J, et al. Sutureless replacement versus transcatheter valve implantation in aortic valve stenosis: a propensity-matched analysis of 2 strategies in high-risk patients. J Thorac Cardiovasc Surg 2014;147:561-7. https://doi.org/10.1016/j.jtcvs.2013.10.025
  4. Di Eusanio M, Phan K. Sutureless aortic valve replacement. Ann Cardiothorac Surg 2015;4:123-30.
  5. Mazine A, Teoh K, Bouhout I, et al. Sutureless aortic valve replacement: a Canadian multicentre study. Can J Cardiol 2015;31:63-8. https://doi.org/10.1016/j.cjca.2014.10.030
  6. Varadarajan P, Kapoor N, Bansal RC, Pai RG. Survival in elderly patients with severe aortic stenosis is dramatically improved by aortic valve replacement: Results from a cohort of 277 patients aged > or =80 years. Eur J Cardiothorac Surg 2006;30:722-7. https://doi.org/10.1016/j.ejcts.2006.07.028
  7. Langanay T, Verhoye JP, Ocampo G, et al. Current hospital mortality of aortic valve replacement in octogenarians. J Heart Valve Dis 2006;15:630-7.
  8. Wenaweser P, Pilgrim T, Kadner A, et al. Clinical outcomes of patients with severe aortic stenosis at increased surgical risk according to treatment modality. J Am Coll Cardiol 2011;58:2151-62. https://doi.org/10.1016/j.jacc.2011.05.063
  9. Flameng W, Herregods MC, Hermans H, et al. Effect of sutureless implantation of the Perceval S aortic valve bioprosthesis on intraoperative and early postoperative outcomes. J Thorac Cardiovasc Surg 2011;142:1453-7. https://doi.org/10.1016/j.jtcvs.2011.02.021
  10. Phan K, Tsai YC, Niranjan N, et al. Sutureless aortic valve replacement: a systematic review and meta-analysis. Ann Cardiothorac Surg 2015;4:100-11.
  11. Reynolds MR, Magnuson EA, Wang K, et al. Health-related quality of life after transcatheter or surgical aortic valve replacement in high-risk patients with severe aortic stenosis: results from the PARTNER (Placement of AoRTic TraNscathetER Valve) Trial (Cohort A). J Am Coll Cardiol 2012;60:548-58. https://doi.org/10.1016/j.jacc.2012.03.075
  12. Laborde F, Fischlein T, Hakim-Meibodi K, et al. Clinical and haemodynamic outcomes in 658 patients receiving the Perceval sutureless aortic valve: early results from a prospective European multicenter study (the Cavalier Trial). Eur J Cardiothorac Surg 2016;49:978-86. https://doi.org/10.1093/ejcts/ezv257
  13. Fischlein T, Meuris B, Hakim-Meibodi K, et al. The sutureless aortic valve at 1 year: a large multicenter cohort study. J Thorac Cardiovasc Surg 2016;151:1617-26.e4. https://doi.org/10.1016/j.jtcvs.2015.12.064
  14. Meuris B, Flameng WJ, Laborde F, Folliguet TA, Haverich A, Shrestha M. Five-year results of the pilot trial of a sutureless valve. J Thorac Cardiovasc Surg 2015;150:84-8. https://doi.org/10.1016/j.jtcvs.2015.03.040
  15. Akins CW, Miller DC, Turina MI, et al. Guidelines for reporting mortality and morbidity after cardiac valve interventions. J Thorac Cardiovasc Surg 2008;135:732-8. https://doi.org/10.1016/j.jtcvs.2007.12.002
  16. Shrestha M, Fischlein T, Meuris B, et al. European multicentre experience with the sutureless Perceval valve: clinical and haemodynamic outcomes up to 5 years in over 700 patients. Eur J Cardiothorac Surg 2016;49:234-41. https://doi.org/10.1093/ejcts/ezv040
  17. Gersak B, Fischlein T, Folliguet TA, et al. Sutureless, rapid deployment valves and stented bioprosthesis in aortic valve replacement: recommendations of an International Expert Consensus Panel. Eur J Cardiothorac Surg 2016; 49:709-18. https://doi.org/10.1093/ejcts/ezv369
  18. Yu WS, Chang BC, Joo HC, Ko YG, Lee S. Comparison of early clinical results of transcatheter versus surgical aortic valve replacement in symptomatic high risk severe aortic stenosis patients. Korean J Thorac Cardiovasc Surg 2013;46:346-52. https://doi.org/10.5090/kjtcs.2013.46.5.346
  19. Reynolds MR, Magnuson EA, Lei Y, et al. Health-related quality of life after transcatheter aortic valve replacement in inoperable patients with severe aortic stenosis. Circulation 2011;124:1964-72. https://doi.org/10.1161/CIRCULATIONAHA.111.040022
  20. Kiefer P, Gruenwald F, Kempfert J, et al. Crimping may affect the durability of transcatheter valves: an experimental analysis. Ann Thorac Surg 2011;92:155-60. https://doi.org/10.1016/j.athoracsur.2011.03.020