双主动脉瓣假体无缝线主动脉瓣植入术的单中心经验

Rings Laura, Ntinopoulos Vasileios, Dushaj Stak, Hoti Gojart, Dzemali Philine Fleckenstein Omer, Häussler Achim
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研究背景和目的:无缝合主动脉瓣用于减少手术时间。然而,支架植入可能会导致术后心电图改变和更高的瓣膜周围渗漏风险。在文献中,一些血小板减少症的病例是在植入后描述的。我们研究了Sorin Perceval S无缝合瓣膜和Edwards Intuity无缝合瓣膜。材料和方法:2015年至2018年间,79名患者在一个中心接受了无缝合瓣膜主动脉瓣置换术。37名患者接受了Sorin Perceval S(A组)和42名Edwards Intuity(B组)。A组23例患者和B组22例患者同时进行了搭桥手术。我们比较了两组患者术后经胸超声心动图和瓣周渗漏、术后心电图改变、起搏器植入需求、术后血小板计数和30天死亡率,其中一例在同一住院时间内再次手术。A组有9名患者发生术后心房颤动,B组有16名患者。A组5例,B组13例,观察到左束支传导阻滞(LBBB)。A组2例需要明确的起搏器,B组5例。B组观察到心动过缓综合征和LBBB的频率更高,心电图也有改变。A组有1例患者在30天内死于多器官衰竭。与平均水平相比,该患者年龄较大且患有多发性疾病。关于血小板计数,我们发现两组患者的血小板计数均有统计学意义的下降。没有重大出血并发症或因出血而再次手术。结论:我们的数据表明,无缝合主动脉瓣置换术后会出现新的心电图改变,在大多数情况下,这种改变是自我限制的。与文献相比,B组的起搏器植入率较高。
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Single-center experience in sutureless aortic valve implantation using two aortic valve prostheses
Background and aim of the study: Sutureless aortic valves are used to reduce operation time. However, the stent implantation might cause postoperative ECG alterations and a higher risk of paravalvular leakage. In literature, some cases of thrombocytopenia are described after implantation. We investigated the Sorin Perceval S Sutureless Valve and the Edwards Intuity Sutureless Valve. Material and methods: Seventy-nine patients underwent aortic valve replacement using a sutureless valve in a single center between 2015 - 2018. Thirty-seven patients received Sorin Perceval S (Group A) and 42 Edwards Intuity (Group B). Simultaneous bypass surgery was performed in 23 patients in Group A and 22 patients in Group B. We compared the groups regarding postoperative TTE and paravalvular leakage, postoperative ECG alterations, need for pacemaker implantation, postoperative platelet count, and 30-day mortality Results: Only in Group B 2 patients had paravalvular leakage, and one was reoperated within the same hospital stay. In Group A, nine patients suffered from postoperative atrial fibrillation, and in Group B, 16 patients. Left bundle branch block (LBBB) was observed in 5 patients in Group A, and 13 patients in Group B. Two patients in Group A needed a definite pacemaker, and five patients in Group B. Tachy-Brady Syndrome and LBBB were observed more frequently in Group B as well as ECG alterations. One patient died within 30 days in Group A due to multiorgan failure. This patient was older and multimorbid compared to the average. Regarding platelet count, we saw a statistically significant decrease in both groups. There were no major bleeding complications or reoperations due to hemorrhage. Conclusion: Our data shows that sutureless aortic valve replacement is associated with new postoperative ECG alterations, which are self-limiting in most cases. Compared to the literature pacemaker implantation rate in Group B is higher.
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