Masiello Paolo, Coscioni Enrico, Panza Antonio, Triumbari Franco, Preziosi Giuseppe, Di Benedetto Giuseppe
Cardiac Surgery Department, S. Giovanni di Dio e Ruggi D'Aragona' Hospital, Salerno, Italy.
Cardiovasc Surg. 2002 Aug;10(4):333-8. doi: 10.1016/s0967-2109(02)00026-1.
the theoretical advantages of mini-invasive cardiac surgery are shorter hospitalisation, better surgical results and costs reduction. In November 1997 we started a non-coronary mini-invasive surgery program using a partial upper median sternotomy. This study has been conceived to retrospectively compare two groups of patients who underwent isolate aortic valve replacement using the conventional and the mini-invasive technique.
in Group A 100 patients (mean age 62+/-12 years; 58 male) underwent isolated aortic valve replacement through a partial upper median sternotomy. Group B was composed by the last 100 patients (mean age 63+/-8 years; 56 male) who underwent the same operation through a conventional median sternotomy. For both groups we recorded the ECC and ischaemic times, postoperative intubation time, total postoperative bleeding, intensive care unit length of stay and total hospitalisation time. Major and minor complications were reported.
operating times, were significantly longer in Group A (p<0.001). Mechanical ventilation time, ICU and total hospital stay, and total postoperative bleeding showed no significant difference. Adjunctive statistical evidenced the absence of learning curve. Mortality and other complications failed to reveal any significant difference between the two groups.
in our experience, partial upper median sternotomy does not increase surgical risks but failed to demonstrate clear advantages. Apart for an increase in operating times, the surgical results are similar to those of a conventional median sternotomy with only improvement in the aesthetical aspect. In our opinion, this supports the conviction that this approach can be proposed to selected patients, to obtain a better cosmethical result for the same given risk.
微创心脏手术的理论优势在于住院时间缩短、手术效果更佳以及成本降低。1997年11月，我们启动了一项使用部分上正中胸骨切开术的非冠状动脉微创手术项目。本研究旨在回顾性比较两组采用传统技术和微创技术进行单纯主动脉瓣置换术的患者。
A组100例患者（平均年龄62±12岁；男性58例）通过部分上正中胸骨切开术进行单纯主动脉瓣置换术。B组由最后100例患者（平均年龄63±8岁；男性56例）组成，他们通过传统正中胸骨切开术进行相同手术。我们记录了两组患者的体外循环和缺血时间、术后插管时间、术后总出血量、重症监护病房住院时间和总住院时间。报告了主要和次要并发症。
A组手术时间明显更长（p<0.001）。机械通气时间、重症监护病房和总住院时间以及术后总出血量无显著差异。辅助统计表明不存在学习曲线。死亡率和其他并发症在两组之间未显示出任何显著差异。
根据我们的经验，部分上正中胸骨切开术不会增加手术风险，但未显示出明显优势。除了手术时间增加外，手术结果与传统正中胸骨切开术相似，仅在美观方面有所改善。我们认为，这支持了这样一种观点，即可以向选定的患者推荐这种方法，在相同的给定风险下获得更好的美容效果。
