Ramphal P S, Irvine R W, Wierenga A, Scarlett M, McGaw C D
Division of Cardiothoracic Surgery, Department of Surgery, Radiology, Anaesthesia and Intensive Care, Faculty of Medical Sciences, University of the West Indies, Kingston 7, Jamaica, West Indies.
West Indian Med J. 2004 Mar;53(2):109-12.
The objective of this study was to examine the consequences of performing single cardiac valve replacement procedures utilizing a beating-heart technique on typical patients presenting to the cardiothoracic surgery service for aortic or mitral valve replacement. Beating heart aortic (4) or mitral valve (1) replacement was performed on patients from July 2000 to November 2002. A stratified sample of five patients who underwent standard arrested-heart single valve replacement procedures between April 1997 and November 2002 was selected for retrospective comparison with the beating-heart group. Operative and post-operative variables were compared between the two groups of patients and subjected to statistical analysis. There was no statistical difference between the two groups with respect to age, pre- or post-operative New York Heart Association (NYHA) scores, cardiopulmonary bypass time, aortic cross-clamp time, intra-operative blood transfusion, or post-operative hospital stay. Post-operatively, in the beating heart group, ventilation time, mediastinal blood loss and requirements for inotropic drugs were significantly reduced (p = 0.0054), p = 0.0019 and 0 = 0.02 respectively) compared to the arrested-heart group. Single cardiac valve replacement surgery utilizing a beating heart technique may offer benefits to patients over traditional arrested-heart surgery. Post-operative blood loss, inotrope requirements and ventilation times are significantly reduced, possibly resulting in better recovery and potentially fewer complications in the post-operative period. There may be cost benefits, important in the context of healthcare delivery in developing nations. These early results suggest the need for a regional prospective randomized trial to compare beating-heart single valve replacement surgery with traditional techniques.
本研究的目的是探讨采用心脏跳动技术进行单心脏瓣膜置换手术，对心胸外科服务中因主动脉瓣或二尖瓣置换而就诊的典型患者的影响。2000年7月至2002年11月期间，对患者进行了心脏跳动下的主动脉瓣（4例）或二尖瓣（1例）置换手术。选取了1997年4月至2002年11月期间接受标准停跳心脏单瓣膜置换手术的5例患者作为分层样本，与心脏跳动组进行回顾性比较。比较两组患者的手术和术后变量，并进行统计分析。两组患者在年龄、术前或术后纽约心脏协会（NYHA）评分、体外循环时间、主动脉阻断时间、术中输血或术后住院时间方面无统计学差异。术后，与停跳心脏组相比，心脏跳动组的通气时间、纵隔失血量和对强心药物的需求显著减少（分别为p = 0.0054、p = 0.0019和p = 0.02）。与传统的停跳心脏手术相比，采用心脏跳动技术进行单心脏瓣膜置换手术可能对患者有益。术后失血量减少且对强心药物的需求减少，通气时间显著缩短，这可能会使患者恢复得更好，且术后并发症可能更少。这可能会带来成本效益，这在发展中国家的医疗服务中很重要。这些早期结果表明，有必要进行一项区域性前瞻性随机试验，以比较心脏跳动下单瓣膜置换手术与传统技术。
