PMID- 16613147
OWN - NLM
STAT- MEDLINE
DCOM- 20060523
LR  - 20061115
IS  - 0021-5252 (Print)
IS  - 0021-5252 (Linking)
VI  - 59
IP  - 4
DP  - 2006 Apr
TI  - [Apicoaortic conduit insertion for elderly patients with acquired aortic stenosis 
      and small aortic annulus].
PG  - 294-300
AB  - BACKGROUND: Patients with critical aortic stenosis, a heavily calcified aorta, 
      and a small aortic annulus are at an increasing risk of complications during a 
      conventional aortic valve replacement (AVR) procedure. Insertion of an 
      apicoaortic conduit (AAC) can be an alternative to AVR in such situations. This 
      study is a review of our experiences with AAC in elderly patients with acquired 
      aortic stenosis. METHOD: From 2001 to 2005, 7 elderly patients (mean age of 81 : 
      range 74 to 87) underwent an AAC insertion for severe symptomatic aortic stenosis 
      with a small aortic annulus (mean annulus size 17.9 mm). Preoperatively, all were 
      symptomatic, with 4 rated as New York Heart Association (NYHA) functional class 
      IV, 2 as class III, and 1 as class II. In addition, 3 patients had severe 
      congestive heart failure with mechanical ventilation and received a high dose 
      administration of catecholamine, and 1 had undergone coronary artery bypass 
      grafting (CABG) previously. RESULT: The AAC insertions were performed under a 
      cardiopulmonary bypass through a left thoracotomy in 6 patients, while 1 patient 
      underwent the procedure without a cardiopulmonary bypass. Distal anastomoses were 
      performed in the descending thoracic aorta with a partial occluding clamp. A 
      composite woven Dacron conduit with a stented biological valve was used in 2 
      cases, and a woven Dacron conduit with a stentless bioprosthesis was used in 5. 
      Two patients underwent a concomitant CABG. There was 1 hospital death due to 
      obstructive ileus 4 months after the operation. One patient who had been in a 
      shock state preoperatively had hypoxic encephalopathy due to inoperative severe 
      hypotension. Postoperative echocardiography showed relief of the left 
      ventricle-aortic gradient in all patients. After a mean follow-up period of 22 
      months, there was no late death, while 3 patients were readmitted due to 
      congestive heart failure. Further, 1 of the patients was rated as NYHA class I, 1 
      as class II, and 2 as class III. CONCLUSION: An AAC procedure was found to be an 
      acceptable alternative for elderly patients who had a high-risk of complications 
      with the standard procedure.
FAU - Takemura, T
AU  - Takemura T
AD  - Department of Cardiovascular Surgery, National Health Organization Nagano 
      Hospital, Ueda, Japan.
FAU - Tsuda, Y
AU  - Tsuda Y
LA  - jpn
PT  - English Abstract
PT  - Journal Article
PL  - Japan
TA  - Kyobu Geka
JT  - Kyobu geka. The Japanese journal of thoracic surgery
JID - 0413533
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Aortic Valve/*surgery
MH  - Aortic Valve Stenosis/*surgery
MH  - Bioprosthesis
MH  - Blood Vessel Prosthesis Implantation/*methods
MH  - Cardiopulmonary Bypass
MH  - Female
MH  - Heart Valve Prosthesis
MH  - Heart Valve Prosthesis Implantation/methods
MH  - Humans
MH  - Male
MH  - Prognosis
MH  - Retrospective Studies
MH  - Stents
EDAT- 2006/04/15 09:00
MHDA- 2006/05/24 09:00
CRDT- 2006/04/15 09:00
PHST- 2006/04/15 09:00 [pubmed]
PHST- 2006/05/24 09:00 [medline]
PHST- 2006/04/15 09:00 [entrez]
PST - ppublish
SO  - Kyobu Geka. 2006 Apr;59(4):294-300.