Vanermen H, Farhat F, Wellens F, De Geest R, Degrieck I, Van Praet F, Vermeulen Y
Department of Thoracic and Cardiovascular Surgery, Onze-Lieve-Vrouw Ziekenhuis, Aalst, Belgium.
J Card Surg. 2000 Jan-Feb;15(1):51-60. doi: 10.1111/j.1540-8191.2000.tb00444.x.
Right thoracotomy is an alternative to mid-sternotomy for left atrium access. The Port-Access approach is an option that reduces the skin incision and obviates rib spreading.
From February 1997 until November 1999, 121 patients underwent mitral valve surgery through a right antero-lateral thoracotomy using the Heartport cardiopulmonary bypass (CPB) system. Mean age was 60 years (31-84). Most patients had normal ejection fractions and were in NYHA Class II or III. Seventy-five patients had valve repair (62%) and 46 (38%) had valve replacement. Pathologies were myxoid (n = 80), rheumatic (n = 30), chronic endocarditis (n = 5), annular dilatation (n = 3), sclerotic (n = 1), ingrowing myxoma (n = 1), and one closure of a paravalvular leak.
Two patients had conversion to sternotomy for aortic dissection (one died) with the Endo-Aortic Clamp, and two others for peripheral vascular problems. One patient died at postoperative day 1 after reoperation for failed repair, another with double valve surgery on postoperative day 4 after two revisions for bleeding. Twelve underwent revision for bleeding (10%). Three had prolonged ICU stay for respiratory insufficiency. Two late valve replacements for endocarditis occurred. Echographic control revealed residual insufficiencies (grade 1-2) in two valvular repairs. There were neither paravalvular leaks nor myocardial infarcts. There were no cerebrovascular accidents due to embolic phenomena. Mean ICU and hospital stay were 2.1 and 8.7 days, with a major difference between the first 30 patients and those who followed.
Port-Access mitral valve surgery can be a valid alternative to conventional sternotomy and seems to be an important improvement in minimally invasive cardiac surgery.
右胸切开术是进入左心房的一种替代正中胸骨切开术的方法。经胸壁端口入路法是一种可减少皮肤切口并避免撑开肋骨的选择。
从1997年2月至1999年11月，121例患者通过右前外侧胸切开术，使用Heartport体外循环（CPB）系统接受二尖瓣手术。平均年龄为60岁（31 - 84岁）。大多数患者射血分数正常，心功能分级为纽约心脏协会（NYHA）Ⅱ级或Ⅲ级。75例患者进行了瓣膜修复（62%），46例（38%）进行了瓣膜置换。病理类型包括黏液样（n = 80）、风湿性（n = 30）、慢性心内膜炎（n = 5）、瓣环扩张（n = 3）、硬化性（n = 1）、内生性黏液瘤（n = 1），以及1例瓣周漏修补。
2例患者因主动脉夹层使用主动脉内阻断钳而转为胸骨切开术（1例死亡），另外2例因外周血管问题转为胸骨切开术。1例患者在修复失败后再次手术后第1天死亡，另1例在因出血进行两次修正后行双瓣膜手术，术后第4天死亡。12例患者因出血接受修正（10%）。3例患者因呼吸功能不全在重症监护病房（ICU）住院时间延长。发生了2例因心内膜炎进行的晚期瓣膜置换。超声心动图检查显示2例瓣膜修复术后有残余反流（1 - 2级）。未发生瓣周漏和心肌梗死。未发生因栓塞现象导致的脑血管意外。ICU平均住院时间和住院时间分别为2.1天和8.7天，前30例患者与后续患者之间存在显著差异。
经胸壁端口入路二尖瓣手术可以是传统胸骨切开术的一种有效替代方法，似乎是微创心脏手术的一项重要进展。
