초록접수 현황
| 16F-135 | 구연 발표 |
Contemporary Surgical Result of Minimally Invasive Aortic Valve Replacement: Comparison with Conventional Full-sternotomy Aortic Valve Replacement
Hyung Gon Je, Sang-Kwon Lee, Jong Myung Park, Mi Hee Lim
Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Pusan National University College of Medicine, Gyeongsangnam-do, Korea
Background : Surgical aortic valve replacement (AVR) is still gold stand for low risk aortic stenosis patients. Minimal invasive AVR has been widely adopted over conventional AVR in many countries but domestic data is not reported yet. Hence, we compared contemporary clinical results of two techniques in domestic patients who underwent isolated, elective AVR.
Methods : Between November 2008 and May 2016, 159 patients underwent a primary isolated aortic valve replacement. Patients needed emergency operation and concomitant surgery were excluded. Of these patients, 89 patients (group M) underwent MIAVR through mini-thoracotomy or mini-sternotomy and 70 patients (group C) underwent CAVR through median sternotomy. Preoperative and postoperative data was compared between groups and among group M, subgroup analysis was conducted between right mini-thoracotomy (n=59) and hemistermotomy (n=30). To detect cerebral silent ischemia, cerebral magnetic resonance image was checked within 14 days after operation in selected patient.
Results : Various preoperative characteristics were comparable between two groups including age, gender, hypertension, diabetes, NYHA class, aortic valve main pathology, left ventricular ejection fraction and estimated surgical mortality calculated by EUROSCORE II system (group C; 3.3±5.6%, group M; 2.1±2.1%, p=0.08). Cardiopulmonary bypass time, aortic cross clamping time, cerebral infarction, silent cerebral ischemia and early mortality (group C; 1.4%, group M; 1.1%, p=1.0) were comparable between groups. Mechanical ventilation time, intensive care unit stay and hospital stay were significantly shorter in group M compare with group C. The amount of chest tube drainage in 12 hours after operation, the incidence of transfusion and rate of reoperation for bleeding was significantly reduced in group M. In subgroup analysis of group M, patients with mini-thoracotomy showed longer CPB and ACC time but shorter hospital stay and mechanical ventilation time. (Table 1.)
Conclusion : MIAVR can facilitate recovery of patient without increasing surgical risk for the patients with low and intermediate risk.
Methods : Between November 2008 and May 2016, 159 patients underwent a primary isolated aortic valve replacement. Patients needed emergency operation and concomitant surgery were excluded. Of these patients, 89 patients (group M) underwent MIAVR through mini-thoracotomy or mini-sternotomy and 70 patients (group C) underwent CAVR through median sternotomy. Preoperative and postoperative data was compared between groups and among group M, subgroup analysis was conducted between right mini-thoracotomy (n=59) and hemistermotomy (n=30). To detect cerebral silent ischemia, cerebral magnetic resonance image was checked within 14 days after operation in selected patient.
Results : Various preoperative characteristics were comparable between two groups including age, gender, hypertension, diabetes, NYHA class, aortic valve main pathology, left ventricular ejection fraction and estimated surgical mortality calculated by EUROSCORE II system (group C; 3.3±5.6%, group M; 2.1±2.1%, p=0.08). Cardiopulmonary bypass time, aortic cross clamping time, cerebral infarction, silent cerebral ischemia and early mortality (group C; 1.4%, group M; 1.1%, p=1.0) were comparable between groups. Mechanical ventilation time, intensive care unit stay and hospital stay were significantly shorter in group M compare with group C. The amount of chest tube drainage in 12 hours after operation, the incidence of transfusion and rate of reoperation for bleeding was significantly reduced in group M. In subgroup analysis of group M, patients with mini-thoracotomy showed longer CPB and ACC time but shorter hospital stay and mechanical ventilation time. (Table 1.)
Conclusion : MIAVR can facilitate recovery of patient without increasing surgical risk for the patients with low and intermediate risk.
책임저자: Hyung Gon Je
Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Pusan National University College of Medicine, Gyeongsangnam-do, Korea
발표자: Hyung Gon Je, E-mail : jehg7332@gmail.com