Cirugia Cardiovascular最新文献

英文中文

Resultados de procedimientos híbridos de cirugía coronaria e implante transcatéter de la válvula aórtica concomitante 冠状动脉手术和同时经导管主动脉瓣植入术的混合手术结果

IF 0.3 Q4 SURGERY

Cirugia Cardiovascular

Pub Date : 2025-07-01 DOI: 10.1016/j.circv.2024.02.012

Carlos Domínguez-Massa , Tomás Heredia-Cambra , Juan Bautista Martínez-León

Introduction and objectives

Coronary artery disease may be present in 40-75% of patients with severe aortic stenosis who undergo transcatheter aortic valve implantation (TAVI). The aim is to evaluate the safety of a hybrid procedure in which coronary artery bypass grafting and TAVI are performed simultaneously with respect to conventional coronary artery bypass grafting and aortic prosthesis implantation with cardiopulmonary bypass.

Methods

Patients who underwent TAVI concomitantly with coronary revascularization off-pump were analyzed, consecutively, from when this procedure began in 2017 until the last patient operated on in 2020 (n = 19), compared with the cases operated on for biological aortic prosthesis implantation, with cardiopulmonary bypass, concomitantly with surgical coronary revascularization, in the last year 2021 (n = 24). Unified Valve Academic Research Consortium 3 (VARC-3) parameters were used.

Results

Regarding the preoperative variables, statistically significant differences were found in mean age (77,89 ± 5,91 years in the TAVI group compared to 70,33 ± 5,48 years in the conventional surgery group; p < 0.001), and in the rate of vascular disease (63,2% vs. 25%; p = 0,012). No differences were found in the number of coronary anastomoses performed between the two groups. In the postoperative results, only statistically significant differences were found in the rate of paravalvular regurgitation (47,4% vs. 8,3%; p = 0.005).

Conclusion

TAVI concomitantly with coronary artery bypass grafting has been shown to be safe with no statistically significant differences in the primary endpoints of mortality, stroke rate, and reoperations, as well as in the combined endpoints of technical success, device success, early safety, and of clinical efficacy.

40-75%的严重主动脉瓣狭窄患者行经导管主动脉瓣植入术（TAVI）时可能存在冠状动脉疾病。目的是评估冠状动脉旁路移植术和TAVI同时进行的混合手术的安全性，相对于传统的冠状动脉旁路移植术和主动脉假体植入体外循环。方法回顾性分析2017年TAVI合并非体外循环冠状动脉重建术开始至2020年最后一次手术的患者（n = 19），与2021年生物主动脉假体植入术合并体外循环合并手术冠状动脉重建术患者（n = 24）进行对比。采用统一阀门学术研究联盟3 （VARC-3）参数。结果术前变量方面，TAVI组患者平均年龄（77,89±5,91岁）与常规手术组患者平均年龄（70,33±5,48岁）比较，差异有统计学意义；p & lt;0.001)，血管疾病发生率(63.2% vs. 25%；p = 0.012)。两组间冠状动脉吻合术数目无差异。在术后结果中，只有瓣旁反流率有统计学意义(47.4% vs 8.3%；p = 0.005)。结论tavi联合冠状动脉旁路移植术是安全的，在死亡率、卒中发生率、再手术等主要终点以及技术成功、器械成功、早期安全性、临床疗效等综合终点均无统计学差异。

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引用次数: 0

Descripción técnica y resultados del implante transcatéter valvular aórtico transcarotídeo. Experiencia de nuestro centro 经颈动脉经导管主动脉瓣植入术的技术描述和结果。本中心的经验

IF 0.3 Q4 SURGERY

Cirugia Cardiovascular

Pub Date : 2025-07-01 DOI: 10.1016/j.circv.2024.01.007

Omar A. Araji-Tiliani , José M. Barquero-Aroca , Rafael Hidalgo-Urbano , Román Calvo-Jambrina

Introduction

Transcatheter aortic valve implantation is the first-line technique in patients older than 75 years. The transfemoral access is the more frequently used, but 15% to 20% of patients have severe peripheral vascular disease, which precludes its use. As an alternative, the axillary route is used and recently the carotid route.

In this paper we present our experience, describe our technique, and report our results with a follow up of 40 months maximum and mean (8,32 ± 10,12 months).

Material and methods

25 patients were operated on during this interval (January 2020-June 2023), 84% men, age 78.88 ± 6.3, 100% hypertensive and with significant peripheral arterial disease, STS score 4.46 ± 0.87, 80% dyslipidemic, 60% NYHA III-IV, 44% chronic renal failure, 80% chronic ischemic heart disease, 28% previous stroke, COPD 48%, 16% patent left internal mammary bypass, and 24% of previous cardiac surgery. The prostheses used were Sapien 3 (36%), Portico-Navitor (60%) and Accurate Neo (4%).

Results

Mortality at 30 days 4%, at one year 9%, AVC 4%, AMI 4%. Implant success 100%, pacemaker implantation 12%. We did not obtain CRF exacerbation, major or minor bleeding, perforation of LV or pericardial effusion, malpositioning or implantation of more than one prosthesis, or coronary obstruction. More than mild periprosthetic insufficiency was 4%.

Conclusions

The transcarotid transcatheter implantation is feasible, with good results, to take into account its use when the femoral and axillary accesses are not suitable.

经导管主动脉瓣植入术是75岁以上患者的一线技术。经股通道是更常用的，但15%至20%的患者有严重的外周血管疾病，因此无法使用。作为一种选择，腋窝路线和最近的颈动脉路线被使用。在本文中，我们介绍了我们的经验，描述了我们的技术，并报告了我们的结果，随访时间最长为40个月，平均为（8,32±10,12个月）。材料与方法在此期间（2020年1月- 2023年6月）手术25例患者，84%为男性，年龄78.88±6.3岁，100%为高血压并伴有明显外周动脉疾病，STS评分4.46±0.87,80%为血脂异常，60%为NYHA III-IV， 44%为慢性肾功能衰竭，80%为慢性缺血性心脏病，28%为既往卒中，COPD 48%， 16%为左侧乳房内搭桥，24%为既往心脏手术。使用的假体分别为Sapien 3（36%）、Portico-Navitor（60%）和Accurate Neo（4%）。结果30天死亡率为4%，1年死亡率为9%，AVC死亡率为4%，AMI死亡率为4%。植入成功率100%，起搏器植入12%。我们没有发现慢性肾功能衰竭加重、大出血或小出血、左室穿孔或心包积液、假体定位错误或植入多个假体或冠状动脉阻塞。超过轻度假体周围功能不全的占4%。结论经颈动脉经导管植入术是可行的，效果良好，但在股、腋通道不适宜时应考虑其使用。

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