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Apicoaortic valved conduit: potential for progress?
1Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden. ulf.lockowand@karolinska.se
Insights
The apicoaortic valved conduit is a viable surgical option for high-risk patients needing aortic valve replacement, offering potential for future improvements in outcomes.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Medical Devices
Background:
- Increasing number of elderly patients require aortic valve replacement.
- Complicating factors like prior coronary bypass grafting and ascending aorta atherosclerosis are common.
- Apicoaortic valved conduit is an uncommon surgical option for aortic valve replacement.
Purpose of the Study:
- To describe the techniques and outcomes of apicoaortic valved conduit insertions.
- To evaluate the feasibility of this procedure in high-risk patients.
Main Methods:
- Retrospective review of 13 high-risk patients undergoing apicoaortic valved conduit insertion from 2002-2005.
- Patients had severe calcific aortic stenosis with complicating factors (porcelain aorta, prior CABG, or both).
- Procedures utilized off-pump techniques or a heparinized miniextracorporeal circulation system.
Main Results:
- Mean intensive care and hospital stays were 2 and 12 days, respectively.
- 30-day mortality was 15% (2 patients), with later mortality at 23% (3 patients).
- 8 surviving patients were in New York Heart Association class I or II at follow-up with low gradients over the conduit.
Conclusions:
- Apicoaortic valved conduit is a feasible option for high-risk patients undergoing aortic valve replacement.
- The procedure demonstrates potential for technical development and improved outcomes.
- Further research and refinement of techniques are warranted.
Objective:
The number of elderly patients who require aortic valve replacement is growing, as is the increase of complicating factors, such as previous coronary bypass grafting and atherosclerotic disease of the ascending aorta. An uncommon surgical option to aortic valve replacement is the apicoaortic valved conduit. In this article the techniques and outcomes of 13 cases of apicoaortic valved conduit insertions in high-risk patients are described.
Methods:
From 2002 through 2005, 13 patients (mean age, 75 +/- 8.7 years; 8 men) with severe calcific aortic stenosis had insertions of an apicoaortic valved conduit because of a porcelain aorta (n = 4), previous coronary bypass grafting (n = 6), or both (n = 3). The off-pump technique was used in 9 patients, and a heparinized miniextracorporeal circulation system was used in 4 patients. Follow-up time was 6 to 33 months.
Results:
Mean intensive care stay was 2 +/- 2.7 days, and mean hospital stay was 12 +/- 8 days. The 30-day mortality was 15% (2 patients; postoperative days 3 and 28, both caused by myocardial infarction). Mortality later than 30 days postoperatively was 23% (3 patients; postoperative day 45 caused by bilateral pulmonary bleeding because of pneumonia, postoperative day 56 caused by myocardial infarction, and postoperative day 81 caused by pneumonia). The remaining 8 patients were doing well, all in New York Heart Association class I or II at follow-up, with echocardiography showing a low gradient over the valved conduit.
Conclusions:
The apicoaortic valved conduit in high-risk patients undergoing aortic valve replacement remains a feasible option, with a substantial potential for technical development and progress.
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