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微创心脏手术的初步经验。

Initial experience with minimally invasive cardiac operations.

作者信息

Costa Francisco, Winter Guilherme, Ferreira Andrea Dumsch de Aragon, Fernandes Tadeu Augusto, Collatusso Claudinei, Tremel Fernanda Tome, Farias Fabio Rocha, Fornazari Daniele de Fátima

机构信息

Departamento de Medicina, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brasil.

出版信息

Rev Bras Cir Cardiovasc. 2012 Jul-Sep;27(3):383-91. doi: 10.5935/1678-9741.20120066.

Abstract

BACKGROUND

Minimally invasive cardiovascular operations have been proposed as an alternative method to correct several cardiac congenital and acquired heart diseases, with the aim to reduce morbidity and mortality.

OBJECTIVES

Describe the two years initial experience with minimally invasive operations, with emphasis on technical aspects and the learning curve.

METHODS

Between July 2009 and March 2012, 95 patients were operated using minimally invasive operations. Mean age was 55 ± 15 years and 53% were females. The operations performed were atrial septal defect closure (25), aortic valve replacement (32), mitral valve repair (23), mitral valve replacement (12), excision of atrial myxoma (2) and resection of subaortic membrane (1). The incision was a mini right thoracotomy in 87 cases and ministernotomy in 8.

RESULTS

Early mortality was 4.2%. Mean size of the incision was 6.3 ±1.2 cm. Extension of the original thoracotomy was necessary in only one case. Two patients suffered a stroke, and the mean total blood loss was 470 ± 277 ml. There were no cases of incision infection and 67% the patients had no major morbidity.

CONCLUSIONS

Our initial results with minimally invasive operations demonstrated that it was safe and with good clinical results. Patient satisfaction is quite high. After the learning phase has been transversed, minimally invasive operations may be an excellent alternative for many patients with congenital and acquired diseases.

摘要

背景

微创心血管手术已被提议作为一种替代方法,用于矫正多种心脏先天性和后天性疾病,目的是降低发病率和死亡率。

目的

描述微创心脏手术的两年初步经验,重点关注技术方面和学习曲线。

方法

2009年7月至2012年3月期间,95例患者接受了微创心脏手术。平均年龄为55±15岁,女性占53%。所进行的手术包括房间隔缺损修补术(25例)、主动脉瓣置换术(32例)、二尖瓣修复术(23例)、二尖瓣置换术(12例)、心房黏液瘤切除术(2例)和主动脉下隔膜切除术(1例)。87例采用右胸小切口,8例采用胸骨下段小切口。

结果

早期死亡率为4.2%。切口平均长度为6.3±1.2厘米。仅1例需要延长原胸壁切口。2例患者发生中风,平均总失血量为470±277毫升。无切口感染病例,67%的患者无严重并发症。

结论

我们的微创心脏手术初步结果表明,该手术安全且临床效果良好。患者满意度较高。在度过学习阶段后,微创心脏手术可能是许多先天性和后天性疾病患者的极佳选择。

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