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(Circulation. 2008;118:1460-1466.)
© 2008 American Heart Association, Inc.

Valvular Heart Disease

Aortic Valve Bypass Surgery

Midterm Clinical Outcomes in a High-Risk Aortic Stenosis Population

James S. Gammie, MD; Leandra S. Krowsoski, BA; James M. Brown, MD; Patrick N. Odonkor, MD; Cindi A. Young; Mary J. Santos, PA-C; John S. Gottdiener, MD; Bartley P. Griffith, MD

From the Divisions of Cardiac Surgery (J.S. Gammie, L.S.K., J.M.B., C.A.Y., M.J.S., B.P.G.) and Cardiology (J.S. Gottdiener) and Department of Anesthesia (P.N.O.), University of Maryland Medical Center, Baltimore.

Correspondence to James S. Gammie, MD, Division of Cardiac Surgery, University of Maryland Medical Center, N4W94, 22 S Greene St, Baltimore, MD 21201. E-mail jgammie{at}smail.umaryland.edu

Received May 2, 2008; accepted July 23, 2008.

Background— Aortic valve bypass (AVB; apicoaortic conduit) surgery relieves aortic stenosis (AS) by shunting blood from the apex of the left ventricle to the descending thoracic aorta through a valved conduit. We have performed AVB surgery as an alternative to conventional aortic valve replacement for high-risk AS patients.

Methods and Results— Between 2003 and 2007, 31 high-risk AS patients were treated with AVB surgery. Twenty-two patients (71%) were undergoing reoperation with patent coronary bypass grafts, and 5 (16%) had a porcelain ascending aorta. The average age was 81 years. Cardiopulmonary bypass was used for 19 of 31 patients (61%); the median duration of cardiopulmonary bypass was 19 minutes. Cross-clamp time for all patients was 0 minutes. Perioperative mortality was 13% (4 of 31 patients); no perioperative deaths occurred in the last 16 consecutive patients. One patient experienced a stroke related to intraoperative hypotension. No strokes have occurred during follow-up. Renal function was unchanged after AVB (preoperative creatinine, 1.3±0.5 mg/dL; postoperative creatinine, 1.2±0.5 mg/dL). The mean gradient across the native aortic valve decreased from 43.5±15 to 10.4±5.4 mm Hg. Echocardiographically determined conduit flow expressed as a percentage of total cardiac output was 72±12%.

Conclusions— AVB surgery is an important therapeutic option for high-risk patients with symptomatic AS. Ventricular outflow is distributed in a predictable fashion between the conduit and the left ventricular outflow tract, and AVB surgery reliably relieves AS. Stroke and renal dysfunction were uncommon.

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CLINICAL PERSPECTIVE

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Clinical Summaries
Circulation 2008 118: 1403-1404. [Extract] [Full Text]