Autor:

Ennker, J.; Florath, I.; Rosendahl, U.; Bauer, S.; Ennker, IC.

Erscheinungsort:

Thorac Cardiovasc Surg 2001; 49 (Suppl 1):39

Inhalt:

Purpose and Subject: Due to the increased life-expectancy in the western population and progress in diagnosis of aortic valve disease by using improved non-invasive techniques more elderly persons require aortic valve replacement (AVR). We were interested in the impact of surgical experience on perioperative outcome of patients undergoing implantation of stentless aortic valves, because of the more demanding implantation technique.

Materials and Methods: Between April 1996 and August 2000 252 patients with a mean age of 74.3±7.3 years underwent AVR using stentless Freestyle® bioprosthesis. 104 (41%) of them required concomitant coronary artery bypass grafting (CABG). The population was divided into four groups of different operation periods with the same sample size.

Results: The operative mortality (within 30 days) declined after the first 60 operations from 6.8% to 1.7%. Within the last two periods the mortality reached a constant level of 3.4%. Over the whole time three valves had to be explanted due to high transvalvular pressure gradients caused by hypertrophy of a small left ventricular outflow tract obstructing the flexible valve. With increased surgical experience more total root procedures were performed (first period (I): 10%, last period (IV): 30%), larger valves were implanted (I: 58%, IV: 85%) and the percentage of patients with a mean transvalvular pressure gradient higher than 30 mmHg postoperatively decreased from 15% to 3%. In the first period the main risk factor for operative death were bleeding events due to valve implantation problems (6.8%, p=0.02) such as tearing of suture lines. This problem could be avoided by reinforcement of the suture line. In the last two periods gastrointestinal complications were the main risk factor for operative death (III: p=0.066; IV: p=0.034) however, the incidence of this complication was not different (p=0.65).

Conclusions: Careful patient selection will help to avoid excessive postoperative transvalvular pressure gradients. Operative mortality in elderly patients undergoing aortic valve replacement using stentless Freestyle® bioprosthesis is decreasing with surgical experience in implantation technique.