Aortic Valve Bypass for the High-Risk Patient With Aortic Stenosis
Interest in percutaneous therapy of heart valve disease has focused attention on the high-risk patient with aortic stenosis. Aortic valve bypass (apicoaortic conduit) surgery is the construction of a vascular graft containing a bioprosthetic valve from the apex of the left ventricle to the descendin...
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| Veröffentlicht in: | The Annals of thoracic surgery 2006-05, Vol.81 (5), p.1605-1610 |
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| container_title | The Annals of thoracic surgery |
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| creator | Gammie, James S. Brown, John W. Brown, Jamie M. Poston, Robert S. Pierson, Richard N. Odonkor, Patrick N. White, Charles S. Gottdiener, John S. Griffith, Bartley P. |
| description | Interest in percutaneous therapy of heart valve disease has focused attention on the high-risk patient with aortic stenosis. Aortic valve bypass (apicoaortic conduit) surgery is the construction of a vascular graft containing a bioprosthetic valve from the apex of the left ventricle to the descending thoracic aorta. We have undertaken a programmatic effort to perform aortic valve bypass surgery as an alternative to conventional aortic valve replacement in selected high-risk patients, and now report our recent experience.
Between April 2003 and May 2005, 14 patients with aortic stenosis underwent aortic valve bypass surgery at two institutions. All patients selected for aortic valve bypass surgery were deemed to be at very high risk for conventional aortic valve replacement. These patients represented 14 (5.8%) of all 243 patients undergoing isolated aortic valve surgery during the same time period. Mean Society of Thoracic Surgeons predicted risk for operative mortality (11%) was between the 90th and 95th percentile.
Twelve of 14 patients had previous cardiac surgery with patent bypass grafts. Average age was 78 years. Mean aortic valve area was 0.68 cm
2. All operations were performed through a left thoracotomy on the beating heart (cross-clamp time, 0 minutes). Cardiopulmonary bypass was used for 6 patients (median cardiopulmonary bypass time, 15 minutes). There were 2 perioperative deaths. Median postoperative length of stay was 9 days. Two noncardiac late deaths occurred. Nine of 10 surviving patients are functional class I and are living independently. Early postoperative echocardiography confirms excellent aortic valve bypass function with preservation of ventricular ejection performance.
Treatment of high-risk aortic stenosis patients with aortic valve bypass surgery is promising. Avoidance of sternotomy and cardiopulmonary bypass supports broader application to moderate-risk patients with aortic stenosis and as a control arm for studies of novel interventional therapies. |
| doi_str_mv | 10.1016/j.athoracsur.2005.11.060 |
| format | Article |
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Between April 2003 and May 2005, 14 patients with aortic stenosis underwent aortic valve bypass surgery at two institutions. All patients selected for aortic valve bypass surgery were deemed to be at very high risk for conventional aortic valve replacement. These patients represented 14 (5.8%) of all 243 patients undergoing isolated aortic valve surgery during the same time period. Mean Society of Thoracic Surgeons predicted risk for operative mortality (11%) was between the 90th and 95th percentile.
Twelve of 14 patients had previous cardiac surgery with patent bypass grafts. Average age was 78 years. Mean aortic valve area was 0.68 cm
2. All operations were performed through a left thoracotomy on the beating heart (cross-clamp time, 0 minutes). Cardiopulmonary bypass was used for 6 patients (median cardiopulmonary bypass time, 15 minutes). There were 2 perioperative deaths. Median postoperative length of stay was 9 days. Two noncardiac late deaths occurred. Nine of 10 surviving patients are functional class I and are living independently. Early postoperative echocardiography confirms excellent aortic valve bypass function with preservation of ventricular ejection performance.
Treatment of high-risk aortic stenosis patients with aortic valve bypass surgery is promising. Avoidance of sternotomy and cardiopulmonary bypass supports broader application to moderate-risk patients with aortic stenosis and as a control arm for studies of novel interventional therapies.</description><identifier>ISSN: 0003-4975</identifier><identifier>EISSN: 1552-6259</identifier><identifier>DOI: 10.1016/j.athoracsur.2005.11.060</identifier><identifier>PMID: 16631642</identifier><identifier>CODEN: ATHSAK</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Aged ; Aged, 80 and over ; Aneurysm, False - diagnostic imaging ; Aortic Valve Stenosis - physiopathology ; Aortic Valve Stenosis - surgery ; Biological and medical sciences ; Cardiology. Vascular system ; Cardiopulmonary Bypass ; Endocardial and cardiac valvular diseases ; Heart ; Heart Valve Prosthesis Implantation - methods ; Hemodynamics ; Humans ; Medical sciences ; Middle Aged ; Postoperative Period ; Retrospective Studies ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the respiratory system ; Thoracotomy ; Tomography, X-Ray Computed</subject><ispartof>The Annals of thoracic surgery, 2006-05, Vol.81 (5), p.1605-1610</ispartof><rights>2006 The Society of Thoracic Surgeons</rights><rights>2006 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c438t-864189597bbdc682ca7385da8e8b630b1d0345e298403b53deaad424efdf85d83</citedby><cites>FETCH-LOGICAL-c438t-864189597bbdc682ca7385da8e8b630b1d0345e298403b53deaad424efdf85d83</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=17758430$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16631642$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gammie, James S.</creatorcontrib><creatorcontrib>Brown, John W.</creatorcontrib><creatorcontrib>Brown, Jamie M.</creatorcontrib><creatorcontrib>Poston, Robert S.</creatorcontrib><creatorcontrib>Pierson, Richard N.</creatorcontrib><creatorcontrib>Odonkor, Patrick N.</creatorcontrib><creatorcontrib>White, Charles S.</creatorcontrib><creatorcontrib>Gottdiener, John S.</creatorcontrib><creatorcontrib>Griffith, Bartley P.</creatorcontrib><title>Aortic Valve Bypass for the High-Risk Patient With Aortic Stenosis</title><title>The Annals of thoracic surgery</title><addtitle>Ann Thorac Surg</addtitle><description>Interest in percutaneous therapy of heart valve disease has focused attention on the high-risk patient with aortic stenosis. Aortic valve bypass (apicoaortic conduit) surgery is the construction of a vascular graft containing a bioprosthetic valve from the apex of the left ventricle to the descending thoracic aorta. We have undertaken a programmatic effort to perform aortic valve bypass surgery as an alternative to conventional aortic valve replacement in selected high-risk patients, and now report our recent experience.
Between April 2003 and May 2005, 14 patients with aortic stenosis underwent aortic valve bypass surgery at two institutions. All patients selected for aortic valve bypass surgery were deemed to be at very high risk for conventional aortic valve replacement. These patients represented 14 (5.8%) of all 243 patients undergoing isolated aortic valve surgery during the same time period. Mean Society of Thoracic Surgeons predicted risk for operative mortality (11%) was between the 90th and 95th percentile.
Twelve of 14 patients had previous cardiac surgery with patent bypass grafts. Average age was 78 years. Mean aortic valve area was 0.68 cm
2. All operations were performed through a left thoracotomy on the beating heart (cross-clamp time, 0 minutes). Cardiopulmonary bypass was used for 6 patients (median cardiopulmonary bypass time, 15 minutes). There were 2 perioperative deaths. Median postoperative length of stay was 9 days. Two noncardiac late deaths occurred. Nine of 10 surviving patients are functional class I and are living independently. Early postoperative echocardiography confirms excellent aortic valve bypass function with preservation of ventricular ejection performance.
Treatment of high-risk aortic stenosis patients with aortic valve bypass surgery is promising. Avoidance of sternotomy and cardiopulmonary bypass supports broader application to moderate-risk patients with aortic stenosis and as a control arm for studies of novel interventional therapies.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Aneurysm, False - diagnostic imaging</subject><subject>Aortic Valve Stenosis - physiopathology</subject><subject>Aortic Valve Stenosis - surgery</subject><subject>Biological and medical sciences</subject><subject>Cardiology. Vascular system</subject><subject>Cardiopulmonary Bypass</subject><subject>Endocardial and cardiac valvular diseases</subject><subject>Heart</subject><subject>Heart Valve Prosthesis Implantation - methods</subject><subject>Hemodynamics</subject><subject>Humans</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Postoperative Period</subject><subject>Retrospective Studies</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the respiratory system</subject><subject>Thoracotomy</subject><subject>Tomography, X-Ray Computed</subject><issn>0003-4975</issn><issn>1552-6259</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2006</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkE1vEzEQhq2qiIaWv1D5Qm-72OuP9R6bqqVIlUBA4Wh57VnisMkGj1Op_x5HWSlHTqPRPO_M6CGEclZzxvXHde3yakrO4z7VDWOq5rxmmp2RBVeqqXSjunOyYIyJSnatuiDvENelbcr4LbngWguuZbMgy9sp5ejpTze-AF2-7hwiHaZE8wroY_y9qr5F_EO_uhxhm-mvmFd0jnzPsJ0w4hV5M7gR4f1cL8nzw_2Pu8fq6cunz3e3T5WXwuTKaMlNp7q274PXpvGuFUYFZ8D0WrCeByakgqYzkoleiQDOBdlIGMJQOCMuyc1x7y5Nf_eA2W4iehhHt4Vpj1a3xnSyYwU0R9CnCTHBYHcpblx6tZzZgz-7tid_9uDPcm6LvxK9nm_s-w2EU3AWVoAPM-DQu3FIbusjnri2VUaKw6LlkYNi5CVCsuiLQQ8hJvDZhin-_5t_1PKSsA</recordid><startdate>20060501</startdate><enddate>20060501</enddate><creator>Gammie, James S.</creator><creator>Brown, John W.</creator><creator>Brown, Jamie M.</creator><creator>Poston, Robert S.</creator><creator>Pierson, Richard N.</creator><creator>Odonkor, Patrick N.</creator><creator>White, Charles S.</creator><creator>Gottdiener, John S.</creator><creator>Griffith, Bartley P.</creator><general>Elsevier Inc</general><general>Elsevier Science</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20060501</creationdate><title>Aortic Valve Bypass for the High-Risk Patient With Aortic Stenosis</title><author>Gammie, James S. ; Brown, John W. ; Brown, Jamie M. ; Poston, Robert S. ; Pierson, Richard N. ; Odonkor, Patrick N. ; White, Charles S. ; Gottdiener, John S. ; Griffith, Bartley P.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c438t-864189597bbdc682ca7385da8e8b630b1d0345e298403b53deaad424efdf85d83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2006</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Aneurysm, False - diagnostic imaging</topic><topic>Aortic Valve Stenosis - physiopathology</topic><topic>Aortic Valve Stenosis - surgery</topic><topic>Biological and medical sciences</topic><topic>Cardiology. Vascular system</topic><topic>Cardiopulmonary Bypass</topic><topic>Endocardial and cardiac valvular diseases</topic><topic>Heart</topic><topic>Heart Valve Prosthesis Implantation - methods</topic><topic>Hemodynamics</topic><topic>Humans</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Postoperative Period</topic><topic>Retrospective Studies</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. 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Aortic valve bypass (apicoaortic conduit) surgery is the construction of a vascular graft containing a bioprosthetic valve from the apex of the left ventricle to the descending thoracic aorta. We have undertaken a programmatic effort to perform aortic valve bypass surgery as an alternative to conventional aortic valve replacement in selected high-risk patients, and now report our recent experience.
Between April 2003 and May 2005, 14 patients with aortic stenosis underwent aortic valve bypass surgery at two institutions. All patients selected for aortic valve bypass surgery were deemed to be at very high risk for conventional aortic valve replacement. These patients represented 14 (5.8%) of all 243 patients undergoing isolated aortic valve surgery during the same time period. Mean Society of Thoracic Surgeons predicted risk for operative mortality (11%) was between the 90th and 95th percentile.
Twelve of 14 patients had previous cardiac surgery with patent bypass grafts. Average age was 78 years. Mean aortic valve area was 0.68 cm
2. All operations were performed through a left thoracotomy on the beating heart (cross-clamp time, 0 minutes). Cardiopulmonary bypass was used for 6 patients (median cardiopulmonary bypass time, 15 minutes). There were 2 perioperative deaths. Median postoperative length of stay was 9 days. Two noncardiac late deaths occurred. Nine of 10 surviving patients are functional class I and are living independently. Early postoperative echocardiography confirms excellent aortic valve bypass function with preservation of ventricular ejection performance.
Treatment of high-risk aortic stenosis patients with aortic valve bypass surgery is promising. Avoidance of sternotomy and cardiopulmonary bypass supports broader application to moderate-risk patients with aortic stenosis and as a control arm for studies of novel interventional therapies.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>16631642</pmid><doi>10.1016/j.athoracsur.2005.11.060</doi><tpages>6</tpages></addata></record> |
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| subjects | Aged Aged, 80 and over Aneurysm, False - diagnostic imaging Aortic Valve Stenosis - physiopathology Aortic Valve Stenosis - surgery Biological and medical sciences Cardiology. Vascular system Cardiopulmonary Bypass Endocardial and cardiac valvular diseases Heart Heart Valve Prosthesis Implantation - methods Hemodynamics Humans Medical sciences Middle Aged Postoperative Period Retrospective Studies Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the respiratory system Thoracotomy Tomography, X-Ray Computed |
| title | Aortic Valve Bypass for the High-Risk Patient With Aortic Stenosis |
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