Wu Zhong, Pan Jun, Wang Qiang, Zhou Qing, Wang Dongjin
Department of Thoracic and Cardiovascular Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.
J Card Surg. 2012 Sep;27(5):533-7. doi: 10.1111/j.1540-8191.2012.01499.x. Epub 2012 Jul 31.
Minimally invasive mitral valve surgery has been proven a safe and cosmetic alternative to the conventional median sternotomy approach. The aim of this study is to retrospectively evaluate the clinical outcome of mitral valve repair for leaflet prolapse through a minimal right vertical infraaxillary thoracotomy (RVIAT).
From January 2003 to December 2011, 68 patients with mitral regurgitation (MR) due to leaflet prolapse underwent mitral valve repair through a RVIAT approach. There were 37 males and 31 females. The mean age of the patients was 37.8 ± 10.5 years. Of the 68 patients, 45 had posterior leaflet prolapse and 23 had anterior leaflet prolapse.
The mean incision length was 7.3 ± 1.8 cm (range 5.5 to 10.0 cm). Mitral valve repair technique included quadrangular resection with or without sliding repair (40 cases), edge to edge technique (six cases), artificial chordae (18 cases), chordal transfer (four cases), and ring annuloplasty was performed in all 68 patients. There was no severe morbidity and operative mortality. Echocardiography after operation demonstrated absence or trivial mitral regurgitation in 52 patients and mild regurgitation in 16 patients. During the 3 months ≈ 8 years' follow-up period, one patient (1.5%) underwent mitral valve replacement through the median sternotomy due to recurrent severe MR. Other patients were in good condition.
Surgical repair of mitral valve prolapse can be successfully performed through the RVIAT approach achieving excellent cosmetic and clinical results.
微创二尖瓣手术已被证明是一种安全且美观的替代传统正中胸骨切开术的方法。本研究的目的是回顾性评估经右腋下垂直小切口（RVIAT）行二尖瓣脱垂修复术的临床结果。
2003年1月至2011年12月，68例因瓣叶脱垂导致二尖瓣反流（MR）的患者经RVIAT入路行二尖瓣修复术。其中男性37例，女性31例。患者的平均年龄为37.8±10.5岁。68例患者中，45例为后叶脱垂，23例为前叶脱垂。
平均切口长度为7.3±1.8cm（范围5.5至10.0cm）。二尖瓣修复技术包括带或不带滑动修复的四边形切除术（40例）、缘对缘技术（6例）、人工腱索（18例）、腱索转移（4例），所有68例患者均行瓣环成形术。无严重并发症及手术死亡。术后超声心动图显示52例患者无或仅有微量二尖瓣反流，16例患者有轻度反流。在3个月至8年的随访期内，1例患者（1.5%）因复发性严重MR经正中胸骨切开术行二尖瓣置换术。其他患者情况良好。
经RVIAT入路可成功进行二尖瓣脱垂的手术修复，获得优异的美容和临床效果。
