Schroeyers P, Wellens F, De Geest R, Degrieck I, Van Praet F, Vermeulen Y, Vanermen H
Department of Cardiovascular and Thoracic Surgery, Onze Lieve Vrouw Ziekenhuis, Aalst, Belgium.
Ann Thorac Surg. 2001 Sep;72(3):S1050-4. doi: 10.1016/s0003-4975(01)02974-5.
Right thoracotomy is a well known alternative to median sternotomy to gain access to the left atrium. To avoid the potential drawbacks associated with sternotomy coupled to the desire for a smaller scar and a more rapid rehabilitation in young and active patients, we investigated the purported advantages in patients undergoing video-assisted Port-Access mitral valve surgery.
Between February 1997 and November 2000, 175 patients (94 men, 81 women) with a mean age of 60 years (range 25 to 84) underwent either Port-Access mitral valve repair (n = 117) or replacement (n = 57) for degenerative disease (n = 112), rheumatic disease (n = 36), chronic endocarditis (n = 15), annular dilatation (n = 8), sclerotic disease (n = 2), and ingrowing myxoma (n = 1). There was one closure of a preexisting paravalvular leak. Standard Carpentier-Edwards repair procedures were used in all patients; in 14 patients polytetrafluoroethylene chordae were inserted for anterior leaflet prolapse. A total of 74 patients (42%) were in New York Heart Association functional class III/IV.
Hospital mortality was 1.1% (n = 2). Four patients had conversion to sternotomy and conventional extra corporeal circulation for repair of a dissected aorta (n = 2) or the inabilty to proceed to a safe femoral cannulation (n = 2). Sixteen patients (9%) underwent a revision for bleeding. Mean cross-clamp time and perfusion time was 95 minutes (range 24 to 160) and 135 minutes (range 75 to 215) respectively. Mean intensive care unit and total hospital stay was 1.8 days (1 to 30) and 8.7 days (4 to 36), respectively. Three patients experienced late acute endocarditis: 2 had late mitral valve replacements and 1 patient had medical therapy for late prosthetic valve endocarditis. There were no myocardial infarctions, cerebrovascular events or peripheral ischemia due to thromboembolic phenomena. No wound complications were observed. The degree of patient satisfaction was very high.
The video-assisted Port-Access mitral valve approach is a valid alternative to sternotomy, with the same standards of results and quality.
右胸切开术是一种众所周知的替代正中胸骨切开术以进入左心房的方法。为了避免与胸骨切开术相关的潜在缺点，并满足年轻且活跃的患者对较小切口瘢痕和更快康复的需求，我们研究了在接受电视辅助经胸壁二尖瓣手术的患者中这种方法的所谓优势。
在1997年2月至2000年11月期间，175例患者（94例男性，81例女性），平均年龄60岁（范围25至84岁），因退行性疾病（n = 112）、风湿性疾病（n = 36）、慢性心内膜炎（n = 15）、瓣环扩张（n = 8）、硬化性疾病（n = 2）和内生性黏液瘤（n = 1）接受了经胸壁二尖瓣修复术（n = 117）或置换术（n = 57）。其中1例为闭合先前存在的瓣周漏。所有患者均采用标准的Carpentier-Edwards修复程序；14例患者因前叶脱垂插入了聚四氟乙烯腱索。共有74例患者（42%）处于纽约心脏协会心功能III/IV级。
医院死亡率为1.1%（n = 2）。4例患者因主动脉夹层修复（n = 2）或无法进行安全的股动静脉插管（n = 2）而转为胸骨切开术并采用传统体外循环。16例患者（9%）因出血接受了再次手术。平均阻断时间和灌注时间分别为95分钟（范围24至160分钟）和135分钟（范围75至215分钟）。平均重症监护病房住院时间和总住院时间分别为1.8天（1至30天）和8.7天（4至36天）。3例患者发生晚期急性心内膜炎：2例接受了晚期二尖瓣置换术，1例患者接受了晚期人工瓣膜心内膜炎的药物治疗。未发生因血栓栓塞现象导致的心肌梗死、脑血管事件或外周缺血。未观察到伤口并发症。患者满意度很高。
电视辅助经胸壁二尖瓣手术方法是胸骨切开术的一种有效替代方法，具有相同的结果标准和质量。
