Perceval免缝合主动脉瓣在胸骨上段/右侧肋间微创小切口主动脉瓣置换术中的应用

Minimally invasive aortic valve replacement with Perceval sutureless aortic bioprosthesis through upper ministernotomy or right anterior thoracotomy

目的评价Perceval免缝合生物瓣在胸骨上段/肋间微创小切口主动脉瓣置换术中应用的临床疗效。方法回顾性纳入2022年3—11月四川大学华西医院心脏大血管外科收治的单纯主动脉瓣病变患者,通过术前评估后成功应用Perceval免缝合生物瓣实施胸骨上段/肋间小切口主动脉瓣置换术,记录患者围术期相关临床资料及超声测量数据。结果共纳入5例单纯主动脉瓣病变患者,其中女3例、男2例,平均年龄71.2岁。5例患者均成功植入Perceval免缝合生物瓣,手术成功率100%,3例经胸骨上段小切口,2例经右侧肋间小切口,其中2例患者同期行升主动脉成形术。术中平均体外循环时间61.0 min,主动脉阻断时间32.2 min。所有患者术后恢复顺利,无瓣周漏、房室传导阻滞、脑卒中等并发症。结论Perceval免缝合生物瓣操作简单,可有效缩短总手术时间、体外循环时间和主动脉阻断时间,降低围术期风险。同时,免缝合生物瓣的临床应用推动了微创主动脉瓣置换术的发展和推广,二者结合有效兼顾了手术疗效和微创化治疗,且安全性和有效性可靠,具有较好的临床应用前景。

Objective To evaluate the clinical effect of minimally invasive aortic valve replacement with Perceval sutureless aortic bioprosthesis in upper ministernotomy or right anterior thoracotomy.Methods From March to November 2022,the patients with simple aortic valve disease were enrolled in the Department of Cardiovascular Surgery of West China Hospital,Sichuan University.After preoperative evaluation,Perceval sutureless bioprosthesis was successfully used to perform aortic valve replacement through the upper ministernotomy or right anterior thoracotomy.The perioperative clinical data and ultrasonic measurement data of all patients were recorded.Results A total of 5 patients with simple aortic valve disease were included,including 3 females and 2 males,with a mean age of 71.2 years.Perceval sutureless bioprosthesis was successfully implanted in 5 patients,with a success rate of 100%.There were 3 patients receiving upper ministernotomy and 2 patients receiving right anterior thoracotomy.Two patients underwent ascending aortic plasty at the same time.The mean cardiopulmonary bypass time was 61.0 min,and aortic cross-clamping time was 32.2 min.All patients were discharged successfully without perivalvular leakage,atrioventricular block or stroke.Conclusion The implantation method of Perceval sutureless bioprosthesis is simple,which can effectively reduce the perioperative risk by shortening the overall operation time,cardiopulmonary bypass time and aortic cross-clamping time.At the same time,its clinical application has promoted the development and popularization of minimally invasive aortic valve replacement,which together with Perceval sutureless bioprosthesis effectively combinates surgical effect and minimally invasive treatment,and has a good clinical application prospect because of its reliable safety and effectiveness.