Clinic for Cardiovascular Surgery, Zurich, Switzerland.
Ann Thorac Surg. 2009 Dec;88(6):1851-6. doi: 10.1016/j.athoracsur.2009.08.015.
This study reports the experiences of minimally invasive aortic valve replacement (MIAVR) through a right minithoracotomy performed in the past 26 months and describes the surgical technique, the learning curve, the complication rate, and the patient outcomes.
From March 2006 to June 2008, 172 patients (113 men; mean age, 71 +/- 12 years) were scheduled for MIAVR (6- to 7-cm incision). Multislice computed tomography (MSCT) imaging was used for surgical planning in 139. Aortic cannulation/clamping were performed through a right-sided minithoracotomy and venous cannulation percutaneously through the groin. For obtaining optimal intercostal space (ICS) distances between the incision to the aorta and cardiac structures, 2- and 3-dimensional MSCT images were evaluated.
Operations were done in 171 patients. MIAVR was successfully performed in 160 (94%). Six patients underwent a conventional operation due to adhesions in 4, small diameter of aortic annulus (17 mm) in 1, and concomitant coronary artery disease in 1. One patient was considered nonoperable. After CT-planning choice of second ICS in 17%, third in 81%, and fourth in 1%. Five conversions to sternotomy were necessary. Intraoperative and postoperative complications occurred in 20 patients, including 1 death. Overall cardiopulmonary bypass was 158 +/- 41 min and cross-clamp time was 107 +/- 26 min. No blood products in 43% of MIAVR patients. Mean hospital length of stay was 10 +/- 3 days.
MIAVR demonstrates excellent results. A considerably reduced complication rate in the course was noted. MSCT for preoperative planning is helpful for an improved mental preparation and for an accurate surgical strategy, including optimal access.
本研究报告了过去 26 个月中通过右胸小切口进行的微创主动脉瓣置换术（MIAVR）的经验，并描述了手术技术、学习曲线、并发症发生率和患者预后。
2006 年 3 月至 2008 年 6 月，172 例患者（男性 113 例；平均年龄 71±12 岁）接受 MIAVR（6-7cm 切口）治疗。139 例患者进行多层螺旋 CT（MSCT）影像学检查用于手术规划。通过右侧小切口进行主动脉插管/钳夹，经腹股沟行静脉插管。为了获得切口与主动脉和心脏结构之间最佳的肋间空间（ICS）距离，评估二维和三维 MSCT 图像。
171 例患者接受了手术。160 例（94%）成功进行了 MIAVR。由于 4 例患者粘连、1 例患者主动脉瓣环直径较小（17mm）、1 例患者合并冠心病，6 例患者改行常规手术。1 例患者被认为不宜手术。在 CT 规划中，17%的患者选择了第二个 ICS，81%的患者选择了第三个 ICS，1%的患者选择了第四个 ICS。需要进行 5 例转为胸骨切开术。20 例患者发生术中及术后并发症，包括 1 例死亡。总体外循环时间为 158±41 分钟，主动脉阻断时间为 107±26 分钟。43%的 MIAVR 患者无需输血。平均住院时间为 10±3 天。
MIAVR 效果良好。术中并发症发生率显著降低。术前规划的 MSCT 有助于改善心理准备和准确的手术策略，包括最佳入路。
