Foghsgaard Signe, Schmidt Thomas Andersen, Kjaergard Henrik K
Department of Cardiothoracic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Tex Heart Inst J. 2009;36(4):293-7.
In this descriptive prospective study, we evaluate the outcomes of surgery in 98 patients who were scheduled to undergo minimally invasive aortic valve replacement. These patients were compared with a group of 50 patients who underwent scheduled aortic valve replacement through a full sternotomy. The 30-day mortality rate for the 98 patients was zero, although 14 of the 98 mini-sternotomies had to be converted to complete sternotomies intraoperatively due to technical problems. Such conversion doubled the operative time over that of the planned full sternotomies. In the group of patients whose operations were completed as mini-sternotomies, 4 died later of noncardiac causes. The aortic cross-clamp and perfusion times were significantly different across all groups (P < 0.001), with the intended full-sternotomy group having the shortest times. In conclusion, the mini-aortic valve replacement is an excellent operation in selected patients, but its true advantages over conventional aortic valve replacement (other than a smaller scar) await evaluation by means of randomized clinical trial. The "extended mini-aortic valve replacement" operation, on the other hand, is a risky procedure that should be avoided by better preoperative evaluation of patients. In any event, the decision to extend a mini-sternotomy to a full sternotomy should be made early in the course of operation, before cardiopulmonary bypass is instituted.
在这项描述性前瞻性研究中，我们评估了98例计划接受微创主动脉瓣置换术患者的手术结果。将这些患者与一组50例通过全胸骨切开术进行计划性主动脉瓣置换术的患者进行比较。98例患者的30天死亡率为零，尽管98例小切口胸骨切开术中的14例因技术问题在术中不得不转为完整的胸骨切开术。这种转换使手术时间比计划的全胸骨切开术增加了一倍。在以小切口胸骨切开术完成手术的患者组中，4例后来死于非心脏原因。所有组的主动脉阻断和灌注时间有显著差异（P < 0.001），预期的全胸骨切开术组时间最短。总之，微创主动脉瓣置换术对选定患者来说是一种很好的手术方式，但其相对于传统主动脉瓣置换术的真正优势（除了疤痕较小之外）有待通过随机临床试验进行评估。另一方面，“扩大微创主动脉瓣置换术”是一种有风险的手术，应通过更好的术前患者评估来避免。无论如何，将小切口胸骨切开术扩大为全胸骨切开术的决定应在建立体外循环之前的手术过程早期做出。
