使用三维视频镜经右胸小切口在心室颤动下进行二尖瓣再次手术。
Mitral valve reoperation under ventricular fibrillation through right mini-thoracotomy using three-dimensional videoscope.
作者信息
Hiraoka Arudo, Kuinose Masahiko, Totsugawa Toshinori, Chikazawa Genta, Yoshitaka Hidenori
机构信息
Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, 2-5-1 Nakaicho, Okayama, Kita-ku 700-0804, Japan.
出版信息
J Cardiothorac Surg. 2013 Apr 12;8:81. doi: 10.1186/1749-8090-8-81.
BACKGROUND
Conventional reoperative mitral valve surgery by median sternotomy has several difficulties. We performed mitral valve replacement (MVR) under ventricular fibrillation (VF) through right mini-thoracotomy with three-dimensional videoscope for avoiding the problems.
METHODS
Between 2006 and 2011, we performed 257 cases of MVR, in which 125 cases underwent isolated MVR. Ten cases of patients underwent reoperative MVR under VF through thoracotomy with three-dimensional videoscope (Group I), and 27 cases of patients underwent reoperative conventional MVR through median sternotomy (Group II). We retrospectively reviewed the outcomes and compared Group I with Group II. Preoperative left ventricular ejection fraction (LVEF) was significantly lower (50.5 ± 19.8% vs 64.4 ± 12.0%; p = 0.046), and significantly higher Euro SCORE was found in Group I (4.8 ± 2.0 vs 3.8 ± 2.4; p = 0.037).
RESULTS
Although Group I required cooling and rewarming time, average operative times was significantly shorter in Group I (262 ± 46 min vs 300 ± 57 min; p = 0.044), and cardiopulmonary bypass times and average VF times in Group I and aortic cross-clamp times in Group II were equivalent. There was no significant difference in the average of postoperative maximum creatine kinase (CK)-MB. In-hospital mortality was 0/10 (0%) and 1/27 (3.7%), and postoperative paravalvular leakage occurred in 0/10 (0%) and 1/27 (3.7%), and stroke occurred in 1/10 (10%) and 1/27 (3.7%) for Groups I and II. Two patients underwent reoperation for bleeding in Group II. Intensive care unit stay in Group I was significantly shorter than in Group II (1.8 ± 0.6 days vs 3.0 ± 1.7 days; p = 0.025).
CONCLUSIONS
The higher risk of preoperative background in Group I had no effect on the operation. Mitral valve surgery under VF through right mini-thoracotomy can be an alternative procedure for reoperation after conventional various cardiothoracic surgeries.
背景
传统的经正中胸骨切开术再次行二尖瓣手术存在诸多困难。我们通过右胸小切口在三维视频镜辅助下于心室颤动（VF）状态下进行二尖瓣置换术（MVR）以避免这些问题。
方法
2006年至2011年期间，我们共进行了257例MVR手术，其中125例为单纯MVR。10例患者通过胸小切口在三维视频镜辅助下于VF状态下进行再次MVR手术（I组），27例患者通过正中胸骨切开术进行传统再次MVR手术（II组）。我们回顾性分析了手术结果并对I组和II组进行比较。I组术前左心室射血分数（LVEF）显著更低（50.5±19.8%对64.4±12.0%；p = 0.046），且I组欧洲心脏手术风险评估系统（Euro SCORE）显著更高（4.8±2.0对3.8±2.4；p = 0.037）。
结果
虽然I组需要降温及复温时间，但I组平均手术时间显著更短（262±46分钟对300±57分钟；p = 0.044），I组的体外循环时间和平均VF时间以及II组的主动脉阻断时间相当。术后最大肌酸激酶（CK）-MB平均值无显著差异。I组住院死亡率为0/10（0%），II组为1/27（3.7%）；I组术后瓣周漏发生率为0/10（0%），II组为1/27（3.7%）；I组和II组卒中发生率分别为1/10（10%）和1/27（3.7%）。II组有2例患者因出血接受再次手术。I组重症监护病房停留时间显著短于II组（1.8±0.6天对3.0±1.7天；p = 0.025）。
结论
I组术前较高的风险背景对手术无影响。通过右胸小切口在VF状态下进行二尖瓣手术可作为传统各种心胸手术后再次手术的一种替代术式。
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