초록접수 현황
| 15F-128 | 구연 발표 |
Ascending Aorta Replacement under Circulatory Arrest for Severe Aortic Calcification in Patients with Aortic Stenosis
박표원, 조양현, 정동섭, 성기익, 김욱성, 이영탁
성균관대학교 의과대학 삼성서울병원 흉부외과학교실
Background : In the era of transcatheter aortic valve implantation (TAVI), extensively calcified ascending aorta is a growing indication for TAVI because aortic cannulation, cross-clamping and aortotomy during aortic valve replacement (AVR) are difficult to manage. The aim of this study was to analyze the outcomes of concomitant AVR and ascending aorta replacement (AAR) using circulatory arrest in patients with both severe aortic stenosis and heavily calcified ascending aorta.
Methods : From 2004 to 2014, a total of 32 patients have undergone AVR and AAR due to severe aortic stenosis and extensive aortic calcification. Patients who had previously undergone cardiac surgery or patients with main pathology of aortic regurgitation were excluded. Mean patient age was 74±7 (range: 59-87) years, and 7 patients (22%) were octogenarian. Mean logistic EuroSCORE was 21±19% (3.3-68.2%). Arterial cannula was placed at ascending aorta (n=26, 81%), aortic arch (n=5, 16%), and axillary artery (n=1, 3%). Circulatory arrest was used for ascending aorta replacement in all patients. Sixty-four patients who had undergone AVR without ascending aorta replacement for severe AS in the same period, were matched for age, sex, coronary artery disease, NYHA functional class, and atrial fibrillation (1:2 matching) to compare the overall survival.
Results : There was no early mortality. Postoperative complications included 1 minor stroke which was recovered without sequela at discharge, 1 transient ischemic attack, 2 pacemaker insertions (1: heart block, 1: sick sinus syndrome after Maze procedure), 1 reoperation for bleeding and 1 acute renal failure. The mean circulatory arrest time for the last 16 patients was significantly shorter than that for initial 16 patients (22.2±3.3 minutes vs 27.4±5.6 minutes, P=0.003). Five-year survival rate was 83±9%, and this was not significantly different from the survival rate of matched patients (5-year survival rate; 86±5%) who had similar baseline characteristics in our AVR database (P=0.661).
Conclusion : Surgical AVR with AAR under circulatory arrest in patients with calcified ascending aorta showed acceptable early and late outcomes. Although the indications of TAVI is growing, surgical approach may still be a valid option for carefully selected patients with ascending aorta calcification.
Methods : From 2004 to 2014, a total of 32 patients have undergone AVR and AAR due to severe aortic stenosis and extensive aortic calcification. Patients who had previously undergone cardiac surgery or patients with main pathology of aortic regurgitation were excluded. Mean patient age was 74±7 (range: 59-87) years, and 7 patients (22%) were octogenarian. Mean logistic EuroSCORE was 21±19% (3.3-68.2%). Arterial cannula was placed at ascending aorta (n=26, 81%), aortic arch (n=5, 16%), and axillary artery (n=1, 3%). Circulatory arrest was used for ascending aorta replacement in all patients. Sixty-four patients who had undergone AVR without ascending aorta replacement for severe AS in the same period, were matched for age, sex, coronary artery disease, NYHA functional class, and atrial fibrillation (1:2 matching) to compare the overall survival.
Results : There was no early mortality. Postoperative complications included 1 minor stroke which was recovered without sequela at discharge, 1 transient ischemic attack, 2 pacemaker insertions (1: heart block, 1: sick sinus syndrome after Maze procedure), 1 reoperation for bleeding and 1 acute renal failure. The mean circulatory arrest time for the last 16 patients was significantly shorter than that for initial 16 patients (22.2±3.3 minutes vs 27.4±5.6 minutes, P=0.003). Five-year survival rate was 83±9%, and this was not significantly different from the survival rate of matched patients (5-year survival rate; 86±5%) who had similar baseline characteristics in our AVR database (P=0.661).
Conclusion : Surgical AVR with AAR under circulatory arrest in patients with calcified ascending aorta showed acceptable early and late outcomes. Although the indications of TAVI is growing, surgical approach may still be a valid option for carefully selected patients with ascending aorta calcification.
책임저자: 박표원
성균관대학교 의과대학 삼성서울병원 흉부외과학교실
연락처 : 박표원, Tel: 02-3410-3481 , E-mail : pwpark@skku.edu
