[经皮冠状动脉介入治疗及微创主动脉瓣置换术治疗主动脉瓣病变及冠状动脉病变]。

Przeglad lekarski Pub Date : 2017-01-01

Jarosław Stoliński, Dariusz Plicner, Michal Mędrzyński, Bogusław Kapelak

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PCI of LAD was\nperformed in 5 patients (9.4%), of Dg\nin 10 (18.9%) patients, of Mg or Cx in\n21 (39.6%) patients, of PDA or RCA in\n25 (47.2%) patients. Two vessels and\nthree vessels PCI were performed in\n5 (9.4%) and 3 (5.7%) patients respectively.\nDES were used during PCI in\n42 (79.2%) patients. Dual antiplatelet\ntherapy with 75 mg of Aspirin and 75\nmg of Clopidogrel started after RTAVR/\nPCI. Complications occurred\nin 16 (30.2%) patients after hybrid\nRT-AVR/PCI procedure. Prolonged\nabove 24 hours mechanical ventilation\ntime was necessary in 3 patients\n(5.7%). Renal insufficiency occurred\nin 4 (7.5%), stroke in 1 (1.9%) patient.\nPacemaker was implanted in 2 (3.8%)\npatients after surgery. Conversion to\nconventional surgery through median\nsternotomy was performed in 1 patient\n(1.9%), surgical revision due to\npostoperative bleeding in 2 patients\n(3.8%). 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摘要

目的:报道经皮冠状动脉介入治疗(PCI)联合右小胸前切开微创主动脉瓣置换术(RT-AVR)治疗主动脉瓣病变合并冠状动脉病变的疗效。材料和方法:回顾性分析53例RT-AVR/PCI混合手术，这些手术首先在手术室进行RT-AVR，然后立即在导管室进行PCI。结果:Euro-SCORE预测住院死亡率为8.7±2.9%，观察住院死亡率为1.9%。住院时间为5.6±2.4天，重症监护时间为1.8±1.4天。40例(75.5%)患者植入生物主动脉瓣假体。LAD患者5例(9.4%)，Dgin患者10例(18.9%)，Mg或Cx患者21例(39.6%)，PDA或RCA患者25例(47.2%)。2支血管PCI 5例(9.4%)，3支血管PCI 3例(5.7%)。42例(79.2%)患者在PCI中使用DES。在RTAVR/PCI后开始75mg阿司匹林和75mg氯吡格雷的双重抗血小板治疗。混合drt - avr /PCI术后出现并发症16例(30.2%)。延长24小时以上机械通气时间3例(5.7%)。肾功能不全4例(7.5%)，卒中1例(1.9%)。2例(3.8%)患者术后植入起搏器。1例(1.9%)患者通过正中胸骨切开术转为常规手术，2例(3.8%)患者因术后出血进行手术翻修。RT-AVR/PCI术后无围手术期心肌梗死和纵隔炎。术后胸腔引血245.0±181.0 ml, 10例(18.9%)患者需要输血。结论:在我们的研究中，与EuroSCOREII预测的常规心脏手术死亡率相比，这些高风险的主动脉瓣疾病和冠状动脉疾病患者的混合RT-AVR/PCI手术的死亡率较低。

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[Percutaneous coronary intervention and minimally invasive aortic valve replacement for patients with aortic valve disease and coronary artery disease].

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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