Seeburger Joerg, Borger Michael Andrew, Falk Volkmar, Kuntze Thomas, Czesla Markus, Walther Thomas, Doll Nicolas, Mohr Friedrich Wilhelm
Department of Cardiac Surgery, Heartcenter, Leipzig University, Struempelstrasse 39, 04289 Leipzig, Germany.
Eur J Cardiothorac Surg. 2008 Oct;34(4):760-5. doi: 10.1016/j.ejcts.2008.05.015. Epub 2008 Jun 30.
Some have expressed concern that minimal invasive mitral valve (MV) repair may not meet the standard of open surgical techniques. We therefore reviewed our results for minimal invasive MV repair for mitral regurgitation (MR).
Between March 1999 and February 2007, a total of 1536 consecutive patients underwent minimal invasive MV surgery for MR at our institution using a right lateral mini-thoracotomy and femoral cannulation for cardiopulmonary bypass. Of these, a total of 1339 (87.2%) patients underwent MV repair and these form the focus of this study. The mean grade of preoperative MR was 3.3+/-0.6, age was 60.3+/-12.7 years, ejection fraction was 59.2+/-15.1% and 819 patients (61.2%) were male.
The procedure was successfully performed in all but four patients (0.3%) who required intraoperative conversion to full sternotomy. MV repair techniques consisted of ring annuloplasty with or without chordae-replacement or Carpentier-type leaflet resection. Concomitant procedures consisted of atrial fibrillation ablation in 351 patients (26.2%), tricuspid valve surgery in 80 patients (6.0%), and patent foramen ovale/atrial septal defect closure in 88 patients (6.6%). Mean duration of CPB was 121+/-38min and mean aortic cross-clamp time was 70+/-32min. Thirty-day mortality was 2.4%. Follow-up was performed in 99% of patients at an average of 28.1+/-23.9 months postoperatively. The Kaplan-Meier estimate for survival at 5 years was 82.6% (95% CI: 78.9-85.7%) and for freedom from MV reoperation was 96.3% (95% CI: 94.6-97.4%).
Minimal invasive MV repair, along with certain concomitant procedures, can be performed in the vast majority of patients with MR. Our large series demonstrates that these procedures can be performed with low perioperative complication rates and very good durability.
一些人担心微创二尖瓣（MV）修复术可能不符合开放手术技术的标准。因此，我们回顾了我们对二尖瓣反流（MR）进行微创MV修复的结果。
1999年3月至2007年2月期间，共有1536例连续患者在我院接受了微创MV手术治疗MR，采用右侧小切口开胸和股动静脉插管进行体外循环。其中，共有1339例（87.2%）患者接受了MV修复，这些患者构成了本研究的重点。术前MR的平均分级为3.3±0.6，年龄为60.3±12.7岁，射血分数为59.2±15.1%，819例（61.2%）患者为男性。
除4例（0.3%）患者术中需要转为全胸骨切开术外，其余患者手术均成功完成。MV修复技术包括带或不带腱索置换的环成形术或Carpentier型瓣叶切除术。同期手术包括351例（26.2%）患者的房颤消融术、80例（6.0%）患者的三尖瓣手术以及88例（6.6%）患者的卵圆孔未闭/房间隔缺损封堵术。体外循环平均持续时间为121±38分钟，平均主动脉阻断时间为70±32分钟。30天死亡率为2.4%。99%的患者进行了随访，术后平均随访时间为28.1±23.9个月。Kaplan-Meier法估计5年生存率为82.6%（95%CI：78.9-85.7%），无MV再次手术率为96.3%（95%CI：94.6-97.4%）。
绝大多数MR患者可以进行微创MV修复术及某些同期手术。我们的大量病例系列表明，这些手术可以在低围手术期并发症发生率和非常好的耐久性的情况下进行。
