Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina 27705, USA.
Ann Thorac Surg. 2009 Dec;88(6):1845-50. doi: 10.1016/j.athoracsur.2009.08.052.
Reports of minimally invasive tricuspid valve operations are rare. We reviewed our experience and results of tricuspid valve operation using mini-thoracotomy during an 11-year period.
Consecutive patients (n = 141) undergoing tricuspid valve operation using mini-thoracotomy were retrospectively analyzed. Access was through a 6-cm right thoracotomy and cardiopulmonary bypass was instituted by means of the femoral artery (n = 16) or ascending aorta (n = 125) with augmented venous return. In most cases, vacuum assist without caval occlusion and snaring the cavae was used to minimize mediastinal dissection. In all cases, the tricuspid valve operation was done with the heart unclamped, and the heart either beating or fibrillating.
Seventy-three percent (103 of 141 patients) of the patients underwent combined mitral and tricuspid valve operations. The tricuspid valve was repaired instead of being replaced in 61% (86 of 141 patients). Previous sternotomy was present in 49% (69 of 141 patients). The average patient age was 64 years. Conversion rate to median sternotomy was only 3% (4 of 141 patients). The mean cardiopulmonary bypass time was 216 minutes. Thirty-day mortality was 2.1% (3 of 141 patients). Stroke occurred in 2.8% (4 of 141 patients), and reexploration for bleeding occurred in 5.6% (8 of 141 patients). The stroke rate was 3 of 16 patients (18.8%) using mini-thoracotomy through femoral cannulation versus 1 of 125 patients (0.8%) through aortic cannulation (p = 0.005).
In this largest reported series of patients undergoing tricuspid valve operation, mini-thoracotomy provides excellent short-term morbidity and mortality in these high-risk patients while avoiding redo sternotomy with a low conversion rate. Mini-thoracotomy with aortic cannulation is an attractive alternative approach to the tricuspid valve, particularly in patients with previous sternotomy.
微创三尖瓣手术的报告很少见。我们回顾了我们在 11 年期间使用小开胸术进行三尖瓣手术的经验和结果。
连续 141 例接受小开胸术的三尖瓣手术患者进行回顾性分析。手术入路为 6cm 右侧开胸，通过股动脉（n=16）或升主动脉（n=125）建立体外循环，并增加静脉回流。在大多数情况下，使用真空辅助而不阻断腔静脉并套扎腔静脉来尽量减少纵隔剥离。在所有情况下，三尖瓣手术均在心不夹闭的情况下进行，心脏跳动或颤动。
73%（141 例患者中的 103 例）的患者同时进行二尖瓣和三尖瓣手术。61%（141 例患者中的 86 例）患者进行三尖瓣修复而非置换。49%（141 例患者中的 69 例）患者既往有正中开胸史。患者平均年龄为 64 岁。转为正中开胸的比例仅为 3%（141 例患者中的 4 例）。平均体外循环时间为 216 分钟。30 天死亡率为 2.1%（141 例患者中的 3 例）。发生卒中 2.8%（141 例患者中的 4 例），再探查出血 5.6%（141 例患者中的 8 例）。经股动脉插管行小开胸术的卒中发生率为 3 例（18.8%），而经主动脉插管的卒中发生率为 1 例（0.8%）（p=0.005）。
在这项最大的报告系列中，接受三尖瓣手术的患者中，小开胸术在这些高危患者中提供了出色的短期发病率和死亡率，同时避免了再次正中开胸，转化率低。主动脉插管小开胸术是一种有吸引力的三尖瓣手术替代方法，特别是对于既往有正中开胸史的患者。
