RESUMEN
OBJECTIVE: High-risk patients with aortic stenosis are increasingly referred to specialist multidisciplinary teams (MDTs) for consideration of trans-catheter aortic valve implantation (TAVI). A subgroup of these cases is unsuitable for TAVI, and high-risk conventional aortic valve replacement (AVR) is undertaken. We have studied our outcomes in this cohort. METHODS: Data prospectively collected between March 2008 and November 2009 for patients (n = 28, nine male) undergoing high-risk AVR were analysed. The mean age was 78.4 ± 9.2 years. The mean additive EuroSCORE (European System for Cardiac Operative Risk Evaluation) was 10.0 ± 3.6 and mean logistic EuroSCORE was 19.9 ± 18.8. Three patients had undergone previous coronary artery bypass grafting (CABG). RESULTS: The mean ejection fraction was 51 ± 16%, mean valve area 0.56 ± 0.19 cm², and mean peak gradient 91 ± 27 mm Hg. Ascending aortic, right axillary artery and femoral artery cannulation was used in 64%, 29% and 7% of cases, respectively. Median cross-clamp and cardiopulmonary bypass times were 84 (68-143) min and 111 (94-223) min. The median (range) inserted valve size was 21 (19-25) mm. Median intensive care and overall hospital stay were 5 (2-37) and 11 (5-44) days, respectively. In-hospital mortality was 4% (one patient). Postoperative complications included re-operation for bleeding (7%), renal failure (21%), tracheostomy (14%), sternal wound infection (7%), atrial fibrillation (25%) and permanent pacemaker implantation (7%). Kaplan-Meier survival at median follow-up of 359 (148-744) days was 81% (one further death of non-cardiac aetiology). Quality-of-life assessment at follow-up also yielded satisfactory results. CONCLUSIONS: MDT assessment of high-risk aortic stenosis in the era of TAVI has increased the number of referrals. Conventional open surgery remains a valid option for these patients, with acceptable in-hospital mortality and early/midterm outcomes but high in-hospital morbidity.
Asunto(s)
Estenosis de la Válvula Aórtica/cirugía , Implantación de Prótesis de Válvulas Cardíacas/métodos , Anciano , Anciano de 80 o más Años , Estenosis de la Válvula Aórtica/rehabilitación , Contraindicaciones , Puente de Arteria Coronaria , Métodos Epidemiológicos , Femenino , Prótesis Valvulares Cardíacas , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/rehabilitación , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Procedimientos Quirúrgicos Mínimamente Invasivos , Diseño de Prótesis , Psicometría , Calidad de Vida , Resultado del TratamientoAsunto(s)
Cateterismo Cardíaco , Arteria Femoral/cirugía , Implantación de Prótesis de Válvulas Cardíacas , Arteria Subclavia/cirugía , Anciano , Anciano de 80 o más Años , Estenosis de la Válvula Aórtica/mortalidad , Estenosis de la Válvula Aórtica/patología , Estenosis de la Válvula Aórtica/cirugía , Cateterismo Cardíaco/efectos adversos , Cateterismo Cardíaco/mortalidad , Estudios de Cohortes , Arteria Femoral/patología , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/mortalidad , Humanos , Estudios Retrospectivos , Arteria Subclavia/patologíaRESUMEN
A 45-year-old lady developed significant symptomatic tricuspid valve stenosis due to a ventriculoatrial (VA) shunt, implanted in childhood for idiopathic hydrocephalus. This appeared to be a rare complication of a VA shunt. After detailed discussions in multidisciplinary meeting, she underwent successful treatment with a single balloon valvuloplasty. To date, she has not suffered any complications.