| Transapical aortic valve implantation: therapy of choice for patients with aortic stenosis and porcelain aorta? | |
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MedLine Citation:
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PMID: 20971240 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Conventional aortic valve replacement can be technically challenging in patients with porcelain aorta and is associated with a high rate of stroke and mortality. Porcelain aorta is even sometimes seen as contraindication for surgery. Minimally invasive off-pump transapical aortic valve implantation may be an optimal strategy to treat elderly patients with porcelain aorta requiring aortic valve replacement. METHODS: Twenty-nine patients with severe aortic stenosis and porcelain aorta underwent transapical aortic valve implantation. Mean age was 79 ± 7.8 years (range, 64 to 93 years), with 65.5% female. Logistic EuroSCORE and the Society of Thoracic Surgeons score were 37.7% ± 18.1% and 12.8% ± 2.2%, respectively. Peripheral vascular disease (41.4%) and carotid artery stenosis (58.6%) were frequent, and 17.2% of patients had experienced a stroke previously. The majority of patients were redo cases (51.2%), and 10.3% were dependent on chronic hemodialysis. In 13.8% of all patients, intraoperatively detected porcelain aorta caused an attempt at conventional aortic valve replacement by means of sternotomy to be aborted. RESULTS: All valves were implanted successfully without embolization or aortic dissection. All procedures were primarily performed off-pump, but 4 patients required secondary cardiopulmonary bypass as a result of complications. Median procedure time was 80 minutes, and median intensive care unit stay was 1 day. Stroke occurred in 1 patient only. Thirty-day mortality was 17.2%. Mild paravalvular leak was seen in 31.0%, and mild to moderate regurgitation occurred in 1 patient. CONCLUSIONS: Transapical aortic valve implantation is a promising approach to treat elderly patients with porcelain aorta requiring aortic valve replacement. It is associated with acceptable outcome and low stroke rates. |
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Authors:
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Jörg Kempfert; Arnaud Van Linden; Axel Linke; Gerhard Schuler; Ardawan Rastan; Sven Lehmann; Lucas Lehmkuhl; Friedrich-Wilhelm Mohr; Thomas Walther |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: The Annals of thoracic surgery Volume: 90 ISSN: 1552-6259 ISO Abbreviation: Ann. Thorac. Surg. Publication Date: 2010 Nov |
Date Detail:
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Created Date: 2010-10-25 Completed Date: 2010-11-10 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 15030100R Medline TA: Ann Thorac Surg Country: Netherlands |
Other Details:
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Languages: eng Pagination: 1457-61 Citation Subset: AIM; IM |
Copyright Information:
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Copyright © 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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Clinic for Cardiac Surgery, University of Leipzig, Heart Center, Leipzig, Germany. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Aged, 80 and over Aortic Diseases / surgery* Aortic Valve / surgery* Aortic Valve Stenosis / surgery* Calcinosis / surgery* Female Heart Valve Prosthesis Implantation / methods* Humans Male Middle Aged |
| Comments/Corrections | |
Comment In:
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Ann Thorac Surg. 2010 Nov;90(5):1461-2
[PMID:
20971241
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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