重症心不全を伴う高齢者に胸骨上半切開で大動脈弁置換術を施行した1例

Aortic Valve Replacement through an Upper Hemisternotomy in an Eldery Patient with Heart Failure：Report of a Case

はじめに　高齢者に対する心臓血管外科手術はフレイリティや複数の慢性疾患をもつことを考慮し，可能な限り低侵襲で行う（低侵襲心臓手術：MICS）必要がある．われわれは，大動脈弁閉鎖不全症（AR）による重度心不全のためdobutamine（DOB）投与中の高齢者に対し，胸骨上半切開（UHS）で大動脈弁置換術（AVR）を施行し，良好な結果を得たので報告する．

Cardiac surgery for elder patients should be minimally invasive because of their frailty and concomitant multiple chronic diseases. We performed aortic valve replacement （AVR） via upper hemisternotomy （UHS） on an 85-year-old patient who suffered from severe aortic regurgitation with dobutamine support. The postoperative course was uneventful. AVR via UHS is safer than that via right axiallary thoracotomy AVR with shorter aortic cross-clamp time, shorter cardiopulmonary bypass time and fewer complications. AVR via UHS makes ambulation and rehabilitation easier than AVR via full sternotomy, because of thoracic stability. It is more effective and should be more prevalent as minimally invasive cardiac surgery for eldery patients with frailty.