Iribarne Alexander, Easterwood Rachel, Chan Edward Y H, Yang Jonathan, Soni Lori, Russo Mark J, Smith Craig R, Argenziano Michael
Division of Cardiothoracic Surgery, Department of Surgery, College of Physicians & Surgeons, Columbia University, New York, NY 10032, USA.
Future Cardiol. 2011 May;7(3):333-46. doi: 10.2217/fca.11.23.
Over the past decade, minimally invasive cardiothoracic surgery (MICS) has grown in popularity. This growth has been driven, in part, by a desire to translate many of the observed benefits of minimal access surgery, such as decreased pain and reduced surgical trauma, to the cardiac surgical arena. Initial enthusiasm for MICS was tempered by concerns over reduced surgical exposure in highly complex operations and the potential for prolonged operative times and patient safety. With innovations in perfusion techniques, refinement of transthoracic echocardiography and the development of specialized surgical instruments and robotic technology, cardiac surgery was provided with the necessary tools to progress to less invasive approaches. However, much of the early literature on MICS focused on technical reports or small case series. The safety and feasibility of MICS have been demonstrated, yet questions remain regarding the relative efficacy of MICS over traditional sternotomy approaches. Recently, there has been a growth in the body of published literature on MICS long-term outcomes, with most reports suggesting that major cardiac operations that have traditionally been performed through a median sternotomy can be performed through a variety of minimally invasive approaches with equivalent safety and durability. In this article, we examine the technological advancements that have made MICS possible and provide an update on the major areas of cardiac surgery where MICS has demonstrated the most growth, with consideration of current and future directions.
在过去十年中，微创心胸外科手术（MICS）越来越受欢迎。这种增长部分是由于人们希望将诸如减少疼痛和降低手术创伤等观察到的微创手术益处应用于心脏外科领域。对MICS的最初热情因对高度复杂手术中手术暴露减少、手术时间延长的可能性以及患者安全的担忧而有所缓和。随着灌注技术的创新、经胸超声心动图的改进以及专业手术器械和机器人技术的发展，心脏外科获得了向侵入性更小的手术方法发展所需的工具。然而，早期关于MICS的许多文献都集中在技术报告或小病例系列上。MICS的安全性和可行性已得到证实，但关于MICS相对于传统胸骨切开术方法的相对疗效仍存在疑问。最近，关于MICS长期结果的已发表文献数量有所增加，大多数报告表明，传统上通过正中胸骨切开术进行的主要心脏手术可以通过多种微创方法进行，且安全性和耐久性相当。在本文中，我们研究了使MICS成为可能的技术进步，并提供了MICS发展最为显著的心脏外科主要领域的最新情况，同时考虑了当前和未来的发展方向。
