二尖瓣手术：胸骨切开术组与端口入路组匹配病例的结局比较。

Mitral valve surgery: comparison of outcomes in matched sternotomy and port access groups.

作者信息

Ryan William H, Brinkman William T, Dewey Todd M, Mack Michael J, Prince Syma L, Herbert Morley A

机构信息

Cardiopulmonary Research Science and Technology Institute, Dallas, Texas, USA.

出版信息

J Heart Valve Dis. 2010 Jan;19(1):51-8; discussion 59.

PMID:20329490

Abstract

BACKGROUND AND AIM OF THE STUDY

The 30-day outcomes were compared between matched groups of patients undergoing mitral valve procedures through Port Access (femoral cannulation, percutaneous retrograde cardioplegia and aortic occlusion), and through a sternotomy.

METHODS

By using a Society of Thoracic Surgeons (STS)-certified, audited database, a total of 1108 patients was identified who were operated on between January 1996 and November 2008. A total of 608 mitral valve repair (MV-Rpr) patients (including 241 with Port Access procedures) and 500 mitral valve replacement (MVR) patients (including 45 with Port Access procedures) was included. Matching groups were created for 177 MV-Rpr patients (matched on preoperative cerebrovascular accident (CVA), previous coronary artery bypass grafting (CABG) and valve procedures, urgent operative status, mitral stenosis, heart failure, NYHA class IV, and age) and for MVR patients with 43 matches (matched for previous CABG surgery, operative status, NYHA class IV, and mitral insufficiency).

RESULTS

Patients with Port Access procedures for MV-Rpr had a shorter length of hospital stay (5.4 +/- 2.8 versus 7.3 +/- 5.8 days), less postoperative ventilator usage (8.4 +/- 36.0 versus 24.8 +/- 81.6 h) and a shorter intensive care unit (ICU) stay (34.0 +/- 40.5 versus 81.7 +/- 133.8 h) when compared to sternotomy cases. Port Access also resulted in fewer patients requiring postoperative ventilation (50.3% versus 76.9%; p < 0.001) or reoperation for bleeding (2.3% versus 6.8%; p = 0.048). In MVR patients, Port Access use led to reductions in mortality (11.6% versus 0%; p = 0.021), ventilation time (13.8 +/- 40.3 versus 38.1 +/- 83.0 h), ICU stay (51.9 +/- 83.4 versus 152.4 +/- 125.0 h) and postoperative hospital stay (8.2 +/- 8.0 versus 11.0 +/- 8.6 days). In both groups, the cross-clamp time was longer with Port Access (107.7 +/- 26.8 versus 92.8 +/- 35.2 min for MV-Rpr; 130.2 +/- 44.2 versus 102.7 +/- 64.6 min for MVR).

CONCLUSION

The performance of mitral valve surgery through a Port Access approach led to a reduction in ICU time, ventilator time, and hospital stay when compared to sternotomy. No increase in morbidity was observed with Port Access compared to sternotomy.

摘要

研究背景与目的

比较经端口入路（股动脉插管、经皮逆行心脏停搏和主动脉阻断）行二尖瓣手术的匹配患者组与经胸骨切开术患者组的30天结局。

方法

利用胸外科医师协会（STS）认证并审核的数据库，共识别出1996年1月至2008年11月期间接受手术的1108例患者。纳入了608例二尖瓣修复（MV-Rpr）患者（包括241例行端口入路手术者）和500例二尖瓣置换（MVR）患者（包括45例行端口入路手术者）。为177例MV-Rpr患者（根据术前脑血管意外（CVA）、既往冠状动脉旁路移植术（CABG）和瓣膜手术、急诊手术状态、二尖瓣狭窄、心力衰竭、纽约心脏协会（NYHA）IV级和年龄进行匹配）和43例匹配的MVR患者（根据既往CABG手术、手术状态、NYHA IV级和二尖瓣关闭不全进行匹配）创建了匹配组。

结果

与胸骨切开术病例相比，行MV-Rpr的端口入路手术患者住院时间更短（5.4±2.8天对7.3±5.8天），术后呼吸机使用时间更少（8.4±36.0小时对24.8±81.6小时），重症监护病房（ICU）停留时间更短（34.0±40.5小时对81.7±133.8小时）。端口入路还导致术后需要通气的患者更少（50.3%对76.9%；p<0.001）或因出血需要再次手术的患者更少（2.3%对6.8%；p = 0.048）。在MVR患者中，使用端口入路导致死亡率降低（11.6%对0%；p = 0.021）、通气时间缩短（13.8±40.3小时对38.1±83.0小时）、ICU停留时间缩短（51.9±83.4小时对152.4±125.0小时）和术后住院时间缩短（8.2±8.0天对11.0±8.6天）。在两组中，端口入路的主动脉阻断时间更长（MV-Rpr为107.7±26.8分钟对92.8±35.2分钟；MVR为130.2±44.2分钟对102.7±64.6分钟）。