Læknablaðið - 15.10.2011, Blaðsíða 15

RANNSÓKN
lýst hefur verið í erlendum rannsóknum, nema hvað hjartaöng er
heldur algengari. Skýringin gæti verið sú að hlutfall eldri sjúklinga
með kransæðasjúkdóm er hátt, en rúmur helmingur sjúklinga
gekkst undir kransæðahjáveituaðgerð samhliða lokuskiptum.
Rannsóknin er afturskyggn og óslembuð sem telst veikleiki,
sérstaklega þegar kemur að því að bera saman árangur
mismunandi lokutegunda. Þessi rannsókn getur því ekki svarað
því hvaða lífræna loka reyndist best, hvorki til skemmri né lengri
tíma. Ótvíræður styrkleiki þessarar rannsóknar er hins vegar að
í henni eru allir sjúklingar sem gengust undir ósæðarlokuskipti
hjá heilli þjóð á fimm ára tímabili. Aðeins þrír skurðlæknar
framkvæmdu aðgerðimar og nákvæmar upplýsingar lágu fyrir
um afdrif allra sjúklinga nema sjö.
í stuttu máli sagt eru snemmkomnir fylgikvillar algengir eftir
ósæðarlokuskipti vegna ósæðarlokuþrengsla, sérstaklega gáttatif
og enduraðgerð vegna blæðinga. Skurðdauði reyndist helmingi
tíðari eftir kransæðahjáveituaðgerðir sem einnig er þekkt í öðrum
rannsóknum.
Þakkir
Þakkir fær Gunnhildur Jóhannsdóttir, skrifstofustjóri á skurðdeild
Landspítala, en einnig Thor Aspelund tölfræðingur og Elín
Maríusdóttir læknir fyrir hjálp við tölfræðilega úrvinnslu. Rann-
sóknin var styrkt af Vísindasjóði Landspítala og Minningarsjóði
Bent Scheving Thorsteinssonar.
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ENGLISH SUMMARY
Aortic valve replacement for aortic stenosis in lceland 2002-2006: Indications and short term complications
Ingvarsdóttir IL, Viktorsson SA, Hreinsson K, Sigurðsson Ml, Helgadóttir S, Arnórsson Þ, Danielsen R, Guðbjartsson T
Objective: Information on surgical outcome of aortic valve replacement (AVR) has not been available in lceland. We therefore studied the indications,
short-term complications and operative mortality in lcelandic patients that underwent AVR with aortic stenosis.
Material and methods: 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 (s30 days) were registered and risk
factors analysed with multivariate analysis.
Results: 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%.
Conclusions: 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.
Key words; Aortic valve replacement, aortic stenosis, outcome, eariy complications, operative mortality.
Correspondence; Tómas Guöbjartsson, tomasgud@landspitali.is
LÆKNAblaðið 2011/97 527