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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
Aortic valve preservation surgery in elderly patients with aortic stenosis
Rodrigo Coelho Segalote1, Pablo Maria Alberto Pomerantzeff, Carlos Manuel de Almeida Brandão
1Heart Institute of the Clinics Hospital, Faculty of Medicine, University of São Paulo, Rua Dr. Enéas de Carvalho Aguiar no. 44, São Paulo-SP, Brazil. segalote@yahoo.com.br
Objective:
The aim of the present study was to investigate early and late results of the aortic valve preservation surgery (AVPS) through rough-hewing, demineralization and commissurotomy of the aortic valve (AV) in aortic stenosis (AS) at elderly people.
Methods:
Thirty-two patients operated for pure AS, older than 65 years-old were studied at InCor FMUSP. Early and late results, clinical (ambulatory and phone interview) and echocardiographic follow-up were investigated. Actuarial and event-free survival analysis was done using the Kaplan-Meier method.
Results:
Four patients (15.4%) had presented de novo AV stenosis. Five patients had progressed to moderate and two to serious aortic regurgitation. Demineralization, commissurotomy and rough-hewing were realized in 28, 20 and 16 patients, respectively. Nine patients had presented serious postoperative complications (28.1%). Two hospital-acquired pneumonia sepsis and five late deaths had occurred. Postoperative NYHA functional status were 70.5%, 17.6%, 5.8% and 5.8% for functional classes I, II, III and IV, respectively. Actuarial eight-year survival rate was 66.9 +/- 12.1%. Eight-year free thromboembolism and endocarditis rate were 90.9 +/- 8.7% and 100%, respectively.
Conclusion:
Aortic valve preservation surgery at the aged with AS was revealed a low morbidity and mortality procedure and presented an eight-year acceptable survival rate and functional status improvement among the studied series of patients.
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