[Percutaneous coronary intervention and minimally invasive aortic valve replacement for patients with aortic valve disease and coronary artery disease].
Przeglad lekarski(2017)
摘要
Objectives:To report the results
of hybrid approach combining percutaneous
coronary intervention (PCI)
and minimally invasive aortic valve
replacement through right anterior
minithoracotomy (RT-AVR) for patients
with aortic valve disease and
coronary artery disease.
Materials and Methods:Retrospective
analysis of 53 hybrid RT-AVR/
PCI procedures where RT-AVR was
performed first in the operating room
and followed immediately by PCI performed
in the catheterization laboratory.
Results:Predicted with Euro-
SCORE II and observed hospital mortality
was 8.7±2.9% and 1.9% respectively.
Hospital and intensive care
unit length of stay were 5.6±2.4 and
1.8±1.4 days respectively. Biological
aortic valve prosthesis was implanted
in 40 (75.5%) patients. PCI of LAD was
performed in 5 patients (9.4%), of Dg
in 10 (18.9%) patients, of Mg or Cx in
21 (39.6%) patients, of PDA or RCA in
25 (47.2%) patients. Two vessels and
three vessels PCI were performed in
5 (9.4%) and 3 (5.7%) patients respectively.
DES were used during PCI in
42 (79.2%) patients. Dual antiplatelet
therapy with 75 mg of Aspirin and 75
mg of Clopidogrel started after RTAVR/
PCI. Complications occurred
in 16 (30.2%) patients after hybrid
RT-AVR/PCI procedure. Prolonged
above 24 hours mechanical ventilation
time was necessary in 3 patients
(5.7%). Renal insufficiency occurred
in 4 (7.5%), stroke in 1 (1.9%) patient.
Pacemaker was implanted in 2 (3.8%)
patients after surgery. Conversion to
conventional surgery through median
sternotomy was performed in 1 patient
(1.9%), surgical revision due to
postoperative bleeding in 2 patients
(3.8%). No perioperative myocardial
infarction and no mediastinitis was
diagnosed after RT-AVR/PCI procedure.
Postoperative chest blood
drainage was 245.0±181.0 ml. Red blood cells transfusion
was required in 10 (18.9%) patients.
Conclusions:The hybrid RT-AVR/PCI procedure for
these high risk patients with aortic valve disease and coronary
artery disease presented in our series favourable
mortality results compared to predicted with EuroSCORE
II mortality for conventional cardiac surgery.
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关键词
invasive aortic valve replacement,percutaneous coronary intervention,aortic valve,aortic valve disease
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