초록접수 현황
| 14F-256 | 구연 발표 |
Midterm Hemodynamic and Clinical Outcomes of Aortic Valve Replacement with Carpentier-edwards Pericardial Aortic Bioprosthesis in Patients with Severe Aortic Stenosis
이교선, 정인석, 오상기, 오봉석, 김상형, 안병희
전남대학교 의과대학 전남대학교병원 흉부외과학교실
Background : The aim of this study was to investigate the midterm hemodynamic and clinical outcomes after aortic valve replacement with the Carpentier-Edwards pericardial bioprosthesis (Edwards Lifesciences LLC, Irvine, CA, USA).
Methods : Between January 2006 and December 2013, the Carpentier-Edwards pericardial valve was used in 103 patients with aortic stenosis. Mean age was 70.5±6.4 years (range 47-87 years) and male was 75 patients (72.8%). All patients had severe aortic stenosis, and 13 of them (13.6%) had combined moderate to severe aortic regurgitation. Associated surgical procedures included coronary artery bypass grafting in 18 patients (17.5%), ascending aorta graft interposition in 9 (8.7%), root enlargement with artificial graft in 3 (2.9%), and modified Maze operation with cryoablator in 3 (2.9%). Two patients had undergone previous cardiac surgery. Aortic valve replacement was performed with interrupt pledget-reinforced stitches and the pledgets were placed supra-annulus. We tried to implant the large aortic valve if possible. Mean indexed effective orifice area was 1.1±0.1 ㎠/㎡ (range 0.9-1.4).
Results : There were 2 early deaths (1.9%). The cause was each low cardiac output syndrome and coronary sinus rupture. There were 10 late cardiac deaths (9.7%). Mean follow-up duration was 31.1±23.1 months (range 0.1-98.2 months). Overall 1- and 5-year survival rate was 93.1% and 82.2%. During follow up period, cerebral embolism was developed in 8 patients (7.8%), bleeding complication was developed in 10 (9.7%) and infective endocarditis in 4 (3.9%). Serial echocardiography was performed and showed mild aortic regurgitation in 4 patients (3.9%) and others were none or trivial. At last echocardiography, mean peak velocity was 2.5±0.4 m/s (range 1.6-3.6) and mean pressure gradient was 13.6±4.6 mmHg (range 4.7-25.0). Mean preoperative left ventricular mass index was 147.4±45.6 g/㎡ at preoperatively and 104.9±25.9 g/㎡ (116.4±49.7 g/㎡ in male and 102.6±49.8 g/㎡ in female) at last follow-up. Twenty patients (male 8 and female 12, 19.4%) had abnormal reference ranges of left ventricular mass index.
Conclusion : The Carpentier-Edwards pericardial bioprosthesis has provided satisfactory hemodynamic and clinical outcome. However, regression of left ventricular mass is insufficient in 20 patients and long-term follow-up is needed.
Methods : Between January 2006 and December 2013, the Carpentier-Edwards pericardial valve was used in 103 patients with aortic stenosis. Mean age was 70.5±6.4 years (range 47-87 years) and male was 75 patients (72.8%). All patients had severe aortic stenosis, and 13 of them (13.6%) had combined moderate to severe aortic regurgitation. Associated surgical procedures included coronary artery bypass grafting in 18 patients (17.5%), ascending aorta graft interposition in 9 (8.7%), root enlargement with artificial graft in 3 (2.9%), and modified Maze operation with cryoablator in 3 (2.9%). Two patients had undergone previous cardiac surgery. Aortic valve replacement was performed with interrupt pledget-reinforced stitches and the pledgets were placed supra-annulus. We tried to implant the large aortic valve if possible. Mean indexed effective orifice area was 1.1±0.1 ㎠/㎡ (range 0.9-1.4).
Results : There were 2 early deaths (1.9%). The cause was each low cardiac output syndrome and coronary sinus rupture. There were 10 late cardiac deaths (9.7%). Mean follow-up duration was 31.1±23.1 months (range 0.1-98.2 months). Overall 1- and 5-year survival rate was 93.1% and 82.2%. During follow up period, cerebral embolism was developed in 8 patients (7.8%), bleeding complication was developed in 10 (9.7%) and infective endocarditis in 4 (3.9%). Serial echocardiography was performed and showed mild aortic regurgitation in 4 patients (3.9%) and others were none or trivial. At last echocardiography, mean peak velocity was 2.5±0.4 m/s (range 1.6-3.6) and mean pressure gradient was 13.6±4.6 mmHg (range 4.7-25.0). Mean preoperative left ventricular mass index was 147.4±45.6 g/㎡ at preoperatively and 104.9±25.9 g/㎡ (116.4±49.7 g/㎡ in male and 102.6±49.8 g/㎡ in female) at last follow-up. Twenty patients (male 8 and female 12, 19.4%) had abnormal reference ranges of left ventricular mass index.
Conclusion : The Carpentier-Edwards pericardial bioprosthesis has provided satisfactory hemodynamic and clinical outcome. However, regression of left ventricular mass is insufficient in 20 patients and long-term follow-up is needed.
책임저자: 안병희
전남대학교 의과대학 전남대학교병원 흉부외과학교실
연락처 : 이교선, Tel: 062-220-6546 , E-mail : waytogosun@naver.com
