Byrne J G, Hsin M K, Adams D H, Aklog L, Aranki S F, Couper G S, Rizzo R J, Cohn L H
Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts 02115,USA.
J Card Surg. 2000 Jan-Feb;15(1):21-34. doi: 10.1111/j.1540-8191.2000.tb00441.x.
We review our experience with minimally invasive direct access (MIDA) heart valve surgery in 518 patients. Two hundred fifty-two patients underwent MIDA aortic valve replacement (AVR) or repair and 266 underwent MIDA mitral valve repair or replacement. Among the 250 AVRs, 157 (63%) were men, aged 63.2 +/- 14.6 years, NYHA functional Class 2.4 +/- 0.8. The surgical approach was right parasternal in 36 (14%) or upper hemisternotomy in 216 (86%). There were four (2%) operative deaths. Perioperative complications included 14 (5.6%) reexplorations for bleeding, 7 (3%) chest wound infections, 5 (2%) strokes, and 1 (0.4%) external iliac vein injury. Follow-up was complete in 193 (77%) patients, with a mean follow-up of 12 +/- 8 months. Late complications included 2 (0.8%) nonfatal myocardial infarctions, 4 (2%) reoperations for, respectively, 2 pericardial complications, 1 paravalvar leak, and 1 infected valve. There were five (2%) late deaths from congestive heart failure, pneumonia, hemorrhage, aneurysm, and cancer. Mean follow-up NYHA Class was 1.4 +/- 0.6. For the 266 mitral patients, 145 (54.5%) were men, age 58.7 +/- 13.6 years, functional Class 2.3 +/- 0.5. The surgical approach was right parasternal in 195 (73%), lower hemisternotomy in 53 (20%), right submammary thoracotomy in 9 (3.4%), or full sternotomy through a small skin incision in 9 (3.4%). There were 2 (0.8%) operative deaths. Perioperative complications included 4 (1.5%) reoperations for bleeding, 4 (1.5%) strokes, and 5 (2%) wound infections, and 3 (1%) ascending aortic complications. Follow-up was complete in 202 (76%) patients with a mean follow-up of 9.5 +/- 6.4 months. Late complications included one (0.4%) nonfatal myocardial infarction and three (1%) reoperations all converting repairs to replacements. There were three (1%) late deaths from suicide, pneumonia, and sudden death, respectively. Mean follow-up NYHA functional Class was 1.3 +/- 0.5. We conclude that MIDA heart valve surgery is safe and effective for the majority of patients requiring isolated elective aortic or mitral valve surgery.
我们回顾了518例患者接受微创直接入路（MIDA）心脏瓣膜手术的经验。252例患者接受了MIDA主动脉瓣置换术（AVR）或修复术，266例患者接受了MIDA二尖瓣修复术或置换术。在250例AVR患者中，157例（63%）为男性，年龄63.2±14.6岁，纽约心脏协会（NYHA）心功能分级为2.4±0.8级。手术入路采用右胸骨旁切口36例（14%）或上半胸骨切开术216例（86%）。有4例（2%）手术死亡。围手术期并发症包括14例（5.6%）因出血再次手术、7例（3%）胸部伤口感染、5例（2%）中风和1例（0.4%）髂外静脉损伤。193例（77%）患者完成随访，平均随访时间为12±8个月。晚期并发症包括2例（0.8%）非致命性心肌梗死、4例（2%）再次手术，分别为2例心包并发症、1例瓣周漏和1例感染性瓣膜。有5例（2%）因充血性心力衰竭、肺炎、出血、动脉瘤和癌症导致的晚期死亡。随访时NYHA平均分级为1.4±0.6级。对于266例二尖瓣手术患者，145例（54.5%）为男性，年龄58.7±13.6岁，心功能分级为2.3±0.5级。手术入路采用右胸骨旁切口195例（73%）、下胸骨切开术53例（20%）、右乳房下胸廓切开术9例（3.4%）或通过小皮肤切口行全胸骨切开术9例（3.4%）。有2例（0.8%）手术死亡。围手术期并发症包括4例（1.5%）因出血再次手术、4例（1.5%）中风、5例（2%）伤口感染和3例（1%）升主动脉并发症。202例（76%）患者完成随访，平均随访时间为9.5±6.4个月。晚期并发症包括1例（0.4%）非致命性心肌梗死和3例（1%）再次手术，均将修复术改为置换术。有3例（1%）晚期死亡，分别为自杀、肺炎和猝死。随访时NYHA平均心功能分级为1.3±0.5级。我们得出结论，对于大多数需要择期孤立性主动脉或二尖瓣手术的患者，MIDA心脏瓣膜手术是安全有效的。
