Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
Scand Cardiovasc J. 2011 Dec;45(6):379-84. doi: 10.3109/14017431.2011.604875. Epub 2011 Aug 19.
Minimal access aortic valve replacement (AVR) has been demonstrated to have beneficial effects over median sternotomy. Minimal extracorporeal circulation (MECC) has been shown to have less deleterious effects than conventional cardiopulmonary bypass. We describe for the first time AVR via upper J-shaped partial sternotomy compared to median sternotomy using MECC.
Prospectively collected pre-operative, intra-operative, post-operative and follow-up data from 104 consecutive patients who underwent minimal access AVR were compared to 72 consecutive patients undergoing median sternotomy using MECC during the same period (January 2007 to December 2009).
No significant differences were found in patient's characteristics or intra-operative data with the exception of pre-existing pulmonary disease. The mean cardiopulmonary bypass (86 ± 18 min vs. 78 ± 15 min, p = 0.0079) and cross-clamp times (65 ± 13 min vs. 59 ± 12 min, p = 0.0013) were significantly shorter in the median sternotomy group. Mediastinal blood loss (397 ± 257 ml vs. 614 ± 339 ml, p < 0.0001) and ventilation time (8 ± 6.9 h vs. 11 ± 16.5 h, p = 0.0054) were significantly less in the minimal access group. No differences were seen in transfusion requirements, inotropic support, intensive care unit (ICU) stay, total hospital stay, post-operative haemoglobin drop, major events or mortality. Quality of life scores after discharge demonstrated less pain with a quicker recovery and return to daily activities in patients receiving J-shaped sternotomy.
Minimal access AVR using MECC is feasible and provides excellent clinical results. Less pain and quicker recovery was experienced among patients in this group.
微创主动脉瓣置换术（AVR）已被证明优于正中开胸术。微创体外循环（MECC）的危害比传统体外循环更小。我们首次描述了使用 MECC 通过上 J 形部分胸骨切开术进行 AVR 与使用 MECC 通过正中开胸术进行 AVR 的比较。
前瞻性收集了 104 例连续接受微创 AVR 的患者的术前、术中、术后和随访数据，并与同期（2007 年 1 月至 2009 年 12 月） 72 例接受 MECC 正中开胸术的患者进行比较。
除了先前存在的肺部疾病外，患者特征或术中数据无显著差异。正中开胸组的体外循环（86 ± 18 分钟对 78 ± 15 分钟，p = 0.0079）和主动脉阻断时间（65 ± 13 分钟对 59 ± 12 分钟，p = 0.0013）更短。微创组的纵隔出血量（397 ± 257 ml 对 614 ± 339 ml，p < 0.0001）和通气时间（8 ± 6.9 小时对 11 ± 16.5 小时，p = 0.0054）更短。输血需求、正性肌力支持、重症监护病房（ICU）入住时间、总住院时间、术后血红蛋白下降、主要事件或死亡率无差异。出院后生活质量评分显示，接受 J 形胸骨切开术的患者疼痛更少，恢复和恢复日常活动的速度更快。
使用 MECC 的微创 AVR 是可行的，可提供良好的临床结果。该组患者疼痛更少，恢复更快。
