Greelish James P, Cohn Lawrence H, Leacche Marzia, Mitchell Michael, Karavas Alexandros, Fox John, Byrne John G, Aranki Sary F, Couper Gregory S
Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
J Thorac Cardiovasc Surg. 2003 Aug;126(2):365-71; discussion 371-3. doi: 10.1016/s0022-5223(03)00078-3.
We began minimally invasive mitral valve surgery in August, 1996, to reduce hospital costs, to improve patient recovery, cosmetic appearance, and to decrease trauma, yet maintain the same quality of surgery. To validate this approach we reviewed our entire experience through May 2002.
From August 1996 to May 2002, we performed 413 minimally invasive mitral valve operations including 51 mitral valve replacements and 362 mitral valve repairs. Excluding 4 robotically assisted repairs, we evaluated 358 patients, using the mitral valve repairs as the basis for this retrospective survey. These operations were performed through a 6- to 8-cm minimally invasive incision, beginning with parasternal and, most recently, lower ministernotomy (181 patients). The mitral valve reparative techniques include repair of 94 prolapsed anterior leaflets, posterior leaflet resection, leaflet advancement, commissuroplasty, Polytetrafluoroethylene (PTFE; Gore-Tex, W. L. Gore & Associates, Inc, Flagstaff, Ariz) chordal placement, and ring annuloplasty. Cannulation sites varied but primarily utilized a miniaturized system of 24F catheters in both the inferior and superior venae cavae with assisted venous suction. The Cosgrove ring was used in 95% of the patients undergoing this procedure.
The operative mortality was 0/358. Perioperative morbidity included a 26% incidence of new atrial fibrillation, 2% incidence of pacemaker implantation, 0.5% incidence of deep sternal wound infection, and 1.9% incidence of stroke after an operation. There were 10 arterial and 3 venous complications. The mean length of stay was 6 days and 208 patients stayed < or =5 days. Only 25% of the patients underwent homologous blood transfusion. The mean follow-up was 36 months with 1.4% lost to follow-up. There were 12 late deaths and a survival at 5 years of 95%. There were 21 valves requiring reoperation for structural valve failure of 5.8%. The probability of freedom from reoperation at 5 years was 92%.
This study documents the safety of minimally invasive mitral valve repair surgery in 358 patients. It also documents a low incidence of homologous blood use, requirement for post-hospital rehabilitation, and general morbidity.
我们于1996年8月开始开展微创二尖瓣手术，以降低医院成本、改善患者恢复情况、美观度并减少创伤，同时保持相同的手术质量。为验证这种方法，我们回顾了截至2002年5月的全部经验。
1996年8月至2002年5月，我们进行了413例微创二尖瓣手术，包括51例二尖瓣置换术和362例二尖瓣修复术。排除4例机器人辅助修复术，我们以二尖瓣修复术为基础对358例患者进行了评估，作为此次回顾性研究。这些手术通过6至8厘米的微创切口进行，最初是胸骨旁切口，最近是低位小胸骨切开术（181例患者）。二尖瓣修复技术包括修复94例脱垂的前叶、后叶切除、叶瓣推进、交界成形术、聚四氟乙烯（PTFE；戈尔特斯，WL戈尔公司，弗拉格斯塔夫，亚利桑那州）腱索置入和环成形术。插管部位各不相同，但主要在上下腔静脉使用24F导管的小型化系统并辅助静脉抽吸。95%接受该手术的患者使用了科斯格罗夫环。
手术死亡率为0/358。围手术期发病率包括新发房颤发生率为26%、起搏器植入发生率为2%、深部胸骨伤口感染发生率为0.5%以及术后中风发生率为1.9%。有10例动脉并发症和3例静脉并发症。平均住院时间为6天，208例患者住院时间≤5天。仅25%的患者接受了同种异体输血。平均随访时间为36个月，失访率为1.4%。有12例晚期死亡，5年生存率为95%。有21个瓣膜因结构性瓣膜功能衰竭需要再次手术，发生率为5.8%。5年无再次手术的概率为92%。
本研究证明了358例患者进行微创二尖瓣修复手术的安全性。它还证明了同种异体输血使用率低、出院后康复需求和总体发病率低。
