Lokuskipti vegna ósæðarlokuþrengsla á Íslandi 2002-2006: Ábendingar og snemmkomnir fylgikvillar
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Authors
Inga Lára Ingvarsdóttir,Sindri Aron Viktorsson
Kári Hreinsson
Martin Ingi Sigurðsson
Sólveig Helgadóttir
Þórarinn Arnórsson
Ragnar Danielsen
Tómas Guðbjartsson
Issue Date
2011-10
Metadata
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[Aortic valve replacement for aortic stenosis in Iceland 2002-2006: Indications and short term complications].Citation
Læknablaðið 2011, 97 (10):523-7Abstract
Information on surgical outcome of aortic valve replacement (AVR) has not been available in Iceland. We therefore studied the indications, short-term complications and operative mortality in Icelandic patients that underwent AVR with aortic stenosis.This was a retrospective study including all patients that underwent AVR for aortic stenosis at Landspitali between 2002 and 2006, a total of 156 patients (average age 71.7 years, 64.7% males). Short term complications and operative mortality (≤ 30 days) were registered and risk factors analysed with multivariate analysis.
The most common symptoms before AVR were dyspnea (86.9%) and angina pectoris (52.6%). Preop. max aortic valve pressure gradient was on average 74 mmHg, the left ventricular ejection fraction 57.2% and EuroSCORE (st) 6.9%. The average operating time was 282 min and concomitant CABG was performed in 55% of the patients and mitral valve surgery in nine. A bioprothesis was implanted in 127 of the patients (81.4%), of which 102 were stentless valves, and a mechanical valve in 29 (18.6%) cases. The mean prosthesis size was 25.6 mm (range 21-29). Atrial fibrillation (78.0%) and acute renal injury (36.0%) were the most common complications and 20 patients (13.0%) developed multiple-organ failure. Twenty-six patients (17.0%) needed reoperation due to bleeding. Median hospital stay was 13 days and operative mortality was 6.4%.
The rate of short term complications following AVR was relatively high, including reoperations for bleeding and atrial fibrillation. Operative mortality is twice that of CABG, which is in line with other studies.
Inngangur: Ósæðarlokuskipti eru önnur algengasta hjartaaðgerðin á Íslandi og er oftast gerð vegna ósæðarlokuþrengsla. Tilgangurinn var að kanna ábendingar, snemmkomna fylgikvilla og skurðdauða eftir þessar aðgerðir hér á landi. Efniviður og aðferðir: Afturskyggn rannsókn á sjúklingum sem gengust undir ósæðarlokuskipti vegna ósæðarlokuþrengsla á Landspítala 2002-2006, samtals 156 einstaklingum. Skráðir voru fylgikvillar aðgerðanna og ein- og fjölþáttagreiningu beitt til að skilgreina áhættuþætti fylgikvilla og skurðdauða innan 30 daga. Niðurstöður: Meðalaldur var 71,7 ár (bil 41-88) og voru karlar 64,7% hópsins. Algengustu einkenni sjúklinga fyrir aðgerð voru mæði (86,9%) og hjartaöng (52,6%). Meðalútfallsbrot hjarta (EF) var 57,2%, hámarksþrýstingsfall (ΔP) yfir lokuna 74,1 mmHg og EuroScore (st) 6,9%. Ríflega helmingur sjúklinganna gekkst samtímis undir kransæðahjáveitu og 9 undir aðgerð á míturloku. Lífrænni loku var komið fyrir í 127 aðgerðanna (81,4%), í 102 tilvikum grindarlausri loku, og gerviloku hjá 29 sjúklingum. Meðalstærð ígræddra loka var 25,6 mm (bil 21-29) og aðgerðartími var 282 mínútur. Algengustu fylgikvillar eftir aðgerð voru nýtilkomið gáttatif (78,0%) og bráður nýrnaskaði (36,0%). Enduraðgerð vegna blæðingar þurfti í 17,0% tilfella og 20 sjúklingar (13,0%) fengu fjöllíffærabilun. Miðgildi legutíma var 13 dagar og 6,4% sjúklinga létust innan 30 daga frá aðgerð. Ályktun: Fylgikvillar reyndust tíðir eftir þessar aðgerðir, einkum gáttatif, nýrnaskaði og blæðingar sem krefjast enduraðgerðar. Skurðdauði er helmingi tíðari en eftir kransæðahjáveituaðgerðir, sem er í samræmi við erlendar rannsóknir.
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