Grossi E A, LaPietra A, Ribakove G H, Delianides J, Esposito R, Culliford A T, Derivaux C C, Applebaum R M, Kronzon I, Steinberg B M, Baumann F G, Galloway A C, Colvin S B
Divisions of Cardiothoracic Surgery and Cardiology, New York University School of Medicine, New York, NY 10028, USA.
J Thorac Cardiovasc Surg. 2001 Apr;121(4):708-13. doi: 10.1067/mtc.2001.112626.
This study compares intermediate-term outcomes of mitral valve reconstruction after either the standard sternotomy approach or the new minimally invasive approach. Although minimally invasive mitral valve operations appear to offer certain advantages, such as reduced postoperative discomfort and decreased postoperative recovery time, the intermediate-term functional and echocardiographic efficacy has not yet been documented.
From May 1996 to February 1999, 100 consecutive patients underwent primary mitral reconstruction through a minimally invasive right anterior thoracotomy and peripheral cardiopulmonary bypass and Port-Access technology (Heartport, Inc, Redwood City, Calif). Outcomes were compared with those for our previous 100 patients undergoing primary mitral repair who were operated on with the standard sternotomy approach.
Although patients were similar in age, the patients undergoing the minimally invasive approach had a lower preoperative New York Heart Association classification (2.1 +/- 0.5 vs 2.6 +/- 0.6, P <.001). There was one (1.0%) hospital mortality with the sternotomy approach and no such case with the minimally invasive approach. Follow-up revealed that residual mitral insufficiency was similar between the minimally invasive and sternotomy approaches (0.79 +/- 0.06 vs 0.77 +/- 0.06, P =.89, 0- to 3-point scale); likewise, the cumulative freedom from reoperation was not significantly different (94.4% vs 96.8%, P =.38). Follow-up New York Heart Association functional class was significantly better in the patients undergoing the minimally invasive approach (1.5 +/- 0.05 vs 1.2 +/- 0.05, P <.01).
These findings demonstrate comparable 1-year follow-up results after minimally invasive mitral valve reconstruction. Both echocardiographic results and New York Heart Association functional improvements were compatible with results achieved with the standard sternotomy approach. The minimally invasive approach for mitral valve reconstruction provides equally durable results with marked advantages for the patient and should be more widely adopted.
本研究比较了标准胸骨切开术式与新型微创术式二尖瓣重建的中期结果。尽管微创二尖瓣手术似乎具有某些优势，如术后不适减轻和术后恢复时间缩短，但中期功能及超声心动图疗效尚未见报道。
1996年5月至1999年2月，连续100例患者通过微创右前外侧开胸、外周体外循环及Port-Access技术（Heartport公司，加利福尼亚州红木城）接受初次二尖瓣重建。将结果与之前采用标准胸骨切开术式接受初次二尖瓣修复的100例患者进行比较。
尽管患者年龄相似，但接受微创术式的患者术前纽约心脏协会分级较低（2.1±0.5对2.6±0.6，P<0.001）。胸骨切开术式有1例（1.0%）医院死亡，微创术式无此类病例。随访显示，微创术式与胸骨切开术式的二尖瓣残余反流相似（0.79±0.06对0.77±0.06，P=0.89，0至3级评分）；同样，再次手术累积自由度无显著差异（94.4%对96.8%，P=0.38）。随访时，接受微创术式的患者纽约心脏协会功能分级显著更好（1.5±0.05对1.2±0.05，P<0.01）。
这些发现表明微创二尖瓣重建术后1年随访结果具有可比性。超声心动图结果及纽约心脏协会功能改善均与标准胸骨切开术式的结果相符。二尖瓣重建的微创术式提供了同样持久的效果，对患者具有显著优势，应更广泛地采用。
