Andrade Wanewman Lins, Amoretti José Ricardo
Royal Spanish Hospital, Salvador, Brazil Portuguese Hospital, Salvador, Brazil Cardio Pulmonar Institute, Salvador, Brazil.
Heart Surg Forum. 2010 Jun;13(3):E165-7. doi: 10.1532/HSF98.20091145.
Minimal-access valve repair was introduced in the 1990s and is becoming an accepted option for patients undergoing valve surgery. Minimally invasive surgical valve repair reduces the degree of surgical insult, produces less postoperative pain, uses less blood, and is associated with better cosmetic results.
Between July 2008 and February 2009, 17 cardiac surgical patients were treated with minimally invasive valve repair at 3 different institutions (Royal Spanish Hospital, Portuguese Hospital, and Cardio Pulmonar Institute, Salvador, Brazil). The heart was accessed via an incision between the ribs in the second or third intercostal space. A retrospective analysis was performed on the outcomes in the first 24 postoperative hours in the intensive care unit and on the fourth postoperative day before the patient's discharge from the hospital.
Of the 17 patients who underwent minimally invasive valve repair and were evaluated, 8 patients (47.05%) underwent aortic surgery, 4 patients (23.52%) underwent mitral valve surgery, 4 patients (23.52%) underwent surgery for a congenital heart defect, and 1 patient (5.88%) underwent endocarditis treatment. The duration of cardiopulmonary bypass (CPB) was <120 minutes in all cases (median interval between lowest and highest CPB times, 90 minutes), and all cross-clamp times were <100 minutes (median interval between lowest and highest cross-clamp times, 70 minutes). There were no cases of reoperation for bleeding, incision infection, or myocardial infarction. The median hospital stay was 5 days; the operative mortality rate was 5.8%.
We conclude that by avoiding full sternotomy, the approach of minimal surgical access contributes to an improved postoperative stability of the chest and less surgical pain. On the other hand, the limited exposure of the heart is a disadvantage of minimally invasive valve repair. Minimally invasive surgical valve repair is safe and feasible with excellent outcomes and is well tolerated in the elderly. Care must be taken to follow the learning curve for operation duration and to treat surgical complications.
微创瓣膜修复术于20世纪90年代引入,正成为瓣膜手术患者可接受的选择。微创外科瓣膜修复术可减轻手术创伤程度,减少术后疼痛,减少输血,并具有更好的美容效果。
2008年7月至2009年2月期间,17例心脏手术患者在3家不同机构(西班牙皇家医院、葡萄牙医院和巴西萨尔瓦多心肺研究所)接受了微创瓣膜修复术。通过第二或第三肋间间隙的肋骨间切口进入心脏。对重症监护病房术后头24小时以及患者出院前术后第四天的结果进行了回顾性分析。
在接受微创瓣膜修复术并接受评估的17例患者中,8例(47.05%)接受了主动脉手术,4例(23.52%)接受了二尖瓣手术,4例(23.52%)接受了先天性心脏缺陷手术,1例(5.88%)接受了心内膜炎治疗。所有病例的体外循环(CPB)时间均<120分钟(CPB最低和最高时间之间的中位间隔为90分钟),所有阻断时间均<100分钟(最低和最高阻断时间之间的中位间隔为70分钟)。没有因出血、切口感染或心肌梗死而再次手术的病例。中位住院时间为5天;手术死亡率为5.8%。
我们得出结论,通过避免全胸骨切开术,微创入路有助于提高术后胸部稳定性并减轻手术疼痛。另一方面,心脏暴露受限是微创瓣膜修复术的一个缺点。微创外科瓣膜修复术安全可行,效果极佳,老年人耐受性良好。必须注意遵循手术持续时间的学习曲线并处理手术并发症。