フレイル高齢者に対する右前方開胸による低侵襲大動脈弁置換術の1例

Right Anterior Minithoracotomy as an Effective Technique for Minimally Invasive Aortic Valve Replacement in Frail and Elderly Patient：Report of a Case

はじめに　高齢者に対する大動脈弁狭窄症の低侵襲治療として，経カテーテル的大動脈弁置換術（transcatheter aortic valve replacement：TAVR）が主流となりつつある．一方，大動脈弁閉鎖不全症に対する治療に関してTAVRは本邦では保険適用外であり，外科的手術が一般的である．ただし高齢者はフレイルを呈することがあり，耐術能の問題で外科的手術に慎重になることがある．われわれはフレイル高齢者に対して，重度の大動脈弁閉鎖不全症による心不全のため，右前方開胸による低侵襲大動脈弁置換術（MICS AVR）を行い良好な結果を得た症例を経験したので，若干の文献的考察を加味して報告する．

Transcatheter aortic valve replacement has increasingly been used as a standard treatment option for patients with aortic valve stenosis, especially in the frail and the elderly. However, it is not recognized as a valid treatment for patients with aortic valve regurgitation. In this study, we report our experience in conducting a right anterior minithoracotomy for a minimally invasive aortic valve replacement in the elderly. An 87-year-old woman with severe aortic valve regurgitation was admitted to our department. Minimally invasive aortic valve replacement was performed, through a right anterior minithoracotomy in the second intercostal space. A localized transverse aortotomy was performed at a position higher than that in an ordinary aortotomy. Our procedure for aortic valve replacement was similar to the conventional method. The postoperative course was uneventful, and the patient was discharged after 10 days. Therefore, we conclude that right anterior minithoracotomy for a minimally invasive aortic valve replacement is a feasible, effective, and safe technique.