经房间隔途径在心脏不停跳二尖瓣手术中的疗效、可行性及陷阱
Efficacy, feasibility, and pitfalls of transseptal approach in beating-heart mitral valve surgery.
作者信息
Salerno Tomas A, Suarez Maria R, Panos Anthony L, Macedo Francisco Igor B, Alba Julia, Brown Michael, Ricci Marco
机构信息
Division of Cardiothoracic Surgery and Perfusion, University of Miami Miller School of Medicine and Jackson Memorial Hospital, Miami, Florida 33136, USA.
出版信息
J Card Surg. 2009 Sep-Oct;24(5):495-8. doi: 10.1111/j.1540-8191.2009.00860.x.
BACKGROUND
Mitral valve surgery can be performed through the trans-atrial or the trans-septal approach. Although the trans-atrial is the preferred method, the trans-septal approach has also been used recently and has a particular value in beating-heart mitral valve surgery. Herein we report our experience with beating-heart mitral valve surgery via trans-septal approach, and discuss its advantages and pitfalls.
METHODS
Between 2000 and 2007, 214 patients underwent mitral valve procedures using the beating-heart surgical approach.
RESULTS
One hundred and forty-three patients (66.8%) had mitral valve replacement, 68 patients (31.7%) mitral valve repair, and 82 patients (38.3%) concomitant valve procedures. Coronary artery bypass grafting was simultaneously performed in 30 (14%) patients. Thirty-day mortality was 7.4%, reoperation for bleeding 7%, stroke 0.4%, and myocardial infarction 0.4%, and failed mitral valve repair 0.9%.
CONCLUSION
Our experience suggests that beating-heart mitral valve surgery is facilitated by using the trans-septal approach.
背景
二尖瓣手术可通过经心房或经房间隔途径进行。虽然经心房途径是首选方法，但经房间隔途径近来也已被采用，且在心脏不停跳二尖瓣手术中有其特殊价值。在此我们报告经房间隔途径心脏不停跳二尖瓣手术的经验，并讨论其优点及缺陷。
方法
2000年至2007年期间，214例患者采用心脏不停跳手术方法接受二尖瓣手术。
结果
143例患者（66.8%）接受二尖瓣置换，68例患者（31.7%）接受二尖瓣修复，82例患者（38.3%）接受同期瓣膜手术。30例（14%）患者同时进行冠状动脉旁路移植术。30天死亡率为7.4%，因出血再次手术率为7%，卒中率为0.4%，心肌梗死率为0.4%，二尖瓣修复失败率为0.9%。
结论
我们的经验表明，采用经房间隔途径有助于心脏不停跳二尖瓣手术。
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