微创与标准入路主动脉瓣置换术：506例患者的研究

Minimally invasive versus standard approach aortic valve replacement: a study in 506 patients.

作者信息

Bakir Ihsan, Casselman Filip P, Wellens Francis, Jeanmart Hugues, De Geest Raphael, Degrieck Ivan, Van Praet Frank, Vermeulen Yvette, Vanermen Hugo

机构信息

Department of Cardiovascular Surgery, Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey.

出版信息

Ann Thorac Surg. 2006 May;81(5):1599-604. doi: 10.1016/j.athoracsur.2005.12.011.

DOI:10.1016/j.athoracsur.2005.12.011

PMID:16631641

Abstract

BACKGROUND

Minimally invasive aortic valve replacement through partial upper sternotomy has been shown to reduce surgical trauma, and, supposedly, decrease postoperative pain, blood loss, and hospital stay.

METHODS

From October 1997 until November 2004, 506 patients received isolated aortic valve replacement, of which 232 underwent the minimal access J-sternotomy approach (group 1). The control group (group 2) consisted of 274 patients who underwent aortic valve replacements by median sternotomy. We retrospectively reviewed outcomes of the patients in the early follow-up period.

RESULTS

In group 1 and group 2, respectively, early mortality was 2.6% (6 patients) and 4.4% (12 patients). The minimal access group had reduced aortic cross-clamp and cardiopulmonary bypass times compared with conventional group: 61.8 +/- 16.6 versus 69.5 +/- 16.6 minutes (p < 0.05) and 88.8 +/- 23.2 versus 100.2 +/- 22.6 minutes (p < 0.05), respectively. Mean blood loss was lower in group 1 compared with group 2 (p < 0.05). Intensive care unit and hospital stays were shorter in the minimal access group: 2.1 +/- 2.5 versus 2.5 +/- 5.3 days (p = nonsignificant) and 10.8 +/- 7.1 versus 12.8 +/- 10.6 days (p < 0.05), respectively.

CONCLUSIONS

Aortic valve replacement can be performed safely through a partial upper sternotomy on a routine basis for isolated aortic valve disease.

摘要

背景

经部分上胸骨切开术进行微创主动脉瓣置换术已被证明可减少手术创伤，并且据推测，可减少术后疼痛、失血和住院时间。

方法

从1997年10月至2004年11月，506例患者接受了单纯主动脉瓣置换术，其中232例采用微创J形胸骨切开术入路（第1组）。对照组（第2组）由274例行正中胸骨切开术进行主动脉瓣置换的患者组成。我们回顾性分析了患者早期随访期的结果。

结果

第1组和第2组的早期死亡率分别为2.6%（6例患者）和4.4%（12例患者）。与传统组相比，微创组的主动脉阻断和体外循环时间缩短：分别为61.8±16.6分钟对69.5±16.6分钟（p<0.05）和88.8±23.2分钟对100.2±22.6分钟（p<0.05）。第1组的平均失血量低于第2组（p<0.05）。微创组的重症监护病房和住院时间较短：分别为2.1±2.5天对2.5±5.3天（p无统计学意义）和10.8±7.1天对12.8±10.6天（p<0.05）。