Torracca Lucia, Lapenna Elisabetta, De Bonis Michele, Kassem Samer, La Canna Giovanni, Crescenzi Giuseppe, Castiglioni Alessandro, Grimaldi Antonio, Alfieri Ottavio
Department of Cardiac Surgery, San Raffaele University Hospital, Via Olgettina 60, 20132 Milan, Italy.
J Cardiovasc Med (Hagerstown). 2006 Jan;7(1):57-60. doi: 10.2459/01.JCM.0000199789.23069.46.
To report our experience with minimally invasive mitral valve repair.
From 1999 to 2003,104 patients underwent mitral valve repair through a right anterolateral minithoracotomy. Most of them were in New York Heart Association functional class I-Il, had normal ejection fraction and were in sinus rhythm. Eighty-five patients suffered from severe mitral regurgitation due to degenerative disease (n = 82) or healed endocarditis (n = 3) and 19 patients had severe mitral stenosis. Sixty-two patients underwent edge-to-edge repair due to anterior/bileaflet prolapse, 23 had a quadrangular resection of the posterior leaflet and 19 a commissurotomy.
No conversions to sternotomy were necessary. Mean cardiopulmonary bypass and aortic cross-clamp times were 75 +/- 14 and 54 +/- 8 min, respectively. Median mechanical ventilation and intensive care unit stay times were 6 and 13 h, respectively. No in-hospital deaths and no major postoperative complications occurred. At a mean follow-up of 27.4 +/- 10.6 months, all patients but two were in New York Heart Association functional class I. The survival rate was 100% and freedom from reoperation was 95.2 +/- 3.3% at 4 years. No or mild residual mitral regurgitation was detected at echocardiography in 100 patients (96%) and moderate insufficiency was found in two (1.9%). The degree of satisfaction in terms of cosmetic result and postoperative discomfort was very high.
Mitral valve repair can be effectively performed through a minimally invasive approach achieving excellent mid-term results and a high degree of patient satisfaction in terms of comfort, cosmetic result and prompt recovery. At our institution, this approach has now become the standard procedure for mitral valve disease in young and active patients.
报告我们在微创二尖瓣修复方面的经验。
1999年至2003年，104例患者通过右前外侧小切口进行二尖瓣修复。他们大多处于纽约心脏协会心功能I-II级，射血分数正常且为窦性心律。85例患者因退行性疾病（n = 82）或愈合性心内膜炎（n = 3）患有严重二尖瓣反流，19例患者患有严重二尖瓣狭窄。62例患者因前叶/双叶脱垂接受缘对缘修复，23例进行后叶四边形切除，19例进行交界切开术。
无需转为胸骨正中切开术。平均体外循环和主动脉阻断时间分别为75±14分钟和54±8分钟。机械通气和重症监护病房停留时间的中位数分别为6小时和13小时。无院内死亡，也未发生重大术后并发症。平均随访27.4±10.6个月时，除2例患者外，所有患者均处于纽约心脏协会心功能I级。4年时生存率为100%，再次手术率为95.2±3.3%。超声心动图检查发现100例患者（96%）无或仅有轻度二尖瓣反流，2例（1.9%）有中度反流。患者对美容效果和术后不适的满意度很高。
二尖瓣修复可通过微创方法有效进行，中期效果良好，患者在舒适度、美容效果和快速康复方面满意度很高。在我们机构，这种方法现已成为年轻且活动能力强的二尖瓣疾病患者的标准手术方式。
