Gulielmos V, Tugtekin S M, Kappert U, Cichon R, Matschke K, Karbalai P, Schueler S
Cardiovascular Institute, University of Dresden, Germany.
J Card Surg. 2000 Jan-Feb;15(1):43-50. doi: 10.1111/j.1540-8191.2000.tb00443.x.
After the promising early results with Port-Access mitral valve (MV) surgery, the mid-term results were evaluated.
Among 31 patients receiving this surgery, there were two subgroups (A and B). The 14 patients in group A (7 men, 7 women, 64.0 +/- 12.8 years, LVEF 0.62 +/- 0.118) received the procedure exactly as proposed by Heartport. The 17 patients in group B (6 men, 11 women, 63.0 +/- 11.48 years, LVEF 0.61 +/- 0.117) received a modified technique for a less complex procedure. The underlying diseases were MV insufficiency (n = 14), MV stenosis (n = 9), and combined MV disease (n = 8). One female patient had a partial atrial ventricular canal.
Perioperative mortality was 3.2%. Survival at 39.0 +/- 6.3 months (median +/- SEM) was 93.5%. Two patients required intraoperative inotropic and mechanical support (intra-aortic balloon pump [IABP]). One of these two patients died on postoperative day 3 due to low cardiac output syndrome. All ther patients survived the procedure. Twenty-four patients underwent MV replacement, 7 patients received MV repair, and 1 patient received, in addition, ASD repair. In group B, operative time, ICU stay, and hospitalization was shorter.
Good early results after Port-Access MV surgery were confirmed by equal mid-term results. The patients are satisfied with the surgical and the cosmetic results, however, Port-Access MV surgery still has to prove superior outcome compared to conventional MV surgery. In selected cases a true reduction of the surgical trauma is possible.
在经胸壁小切口二尖瓣（MV）手术取得早期良好结果之后，对其中期结果进行了评估。
在接受该手术的31例患者中，分为两个亚组（A组和B组）。A组14例患者（7例男性，7例女性，年龄64.0±12.8岁，左心室射血分数[LVEF]0.62±0.118）按照Heartport公司提出的方案准确进行手术。B组17例患者（6例男性，11例女性，年龄63.0±11.48岁，LVEF0.61±0.117）采用改良技术进行较简单的手术。基础疾病为二尖瓣关闭不全（n = 14）、二尖瓣狭窄（n = 9）和二尖瓣联合病变（n = 8）。1例女性患者患有部分房室通道。
围手术期死亡率为3.2%。在39.0±6.3个月（中位数±标准误）时的生存率为93.5%。2例患者术中需要使用正性肌力药物和机械支持（主动脉内球囊反搏[IABP]）。这2例患者中有1例因低心排血量综合征于术后第3天死亡。其他所有患者手术存活。24例患者接受了二尖瓣置换术，7例患者接受了二尖瓣修复术，1例患者还接受了房间隔缺损修复术。B组的手术时间、重症监护病房（ICU）停留时间和住院时间较短。
经胸壁小切口二尖瓣手术的早期良好结果在中期结果中得到了证实。患者对手术和美容效果满意，然而，与传统二尖瓣手术相比，经胸壁小切口二尖瓣手术仍需证明其具有更好的疗效。在某些特定病例中，手术创伤确实有可能真正减少。
