Ward Alison F, Grossi Eugene A, Galloway Aubrey C
Department of Cardiothoracic Surgery, New York University School of Medicine, New York, NY 10016, USA.
J Thorac Dis. 2013 Nov;5 Suppl 6(Suppl 6):S673-9. doi: 10.3978/j.issn.2072-1439.2013.10.09.
In the 1990s, the success of 'minimally invasive' laparoscopic operations in other surgical subspecialties sparked an interest in minimally-invasive approaches for cardiac surgery, specifically for mitral valve repair. In 1996 at New York University (NYU) we began our experience with minimally invasive mitral valve repair performed through a small right anterior mini-thoracotomy incision using the Port-Access system in a phase I clinical trial. This was the beginning of our extensive right mini-thoracotomy experience for mitral valve repair at NYU. Currently at our institution the preferred approach for the right mini-thoracotomy mitral valve surgery is through the 3rd or 4th interspace mini-thoracotomy incision. Perfusion is accomplished with direct aortic or femoral cannulation, long femoral venous cannula drainage, and a retrograde cardioplegia catheter placed trans-atrialy in the coronary sinus under TEE guidance. An antegrade cardioplegia and venting needle is placed in the ascending aorta and direct external aortic clamping is achieved with one of several specialized crossclamps. With over four decades of experience, more than 4,000 patients have undergone mitral valve repair at NYU including 1,922 performed through a right mini-thoracotomy. We have reported an overall operative mortality of 1.3%, 8-year freedom from reoperation of 95%, freedom from reoperation or severe recurrent mitral regurgitation of 93%, and freedom from all valve-related complications of 90% for our initial series of 1,071 right mini-thoracotomy mitral valve repair. Based on our extensive experience we believe that mitral valve repair through a right mini-thoracotomy provides a durable and safe alternative to a traditional sternotomy with the benefits of improved cosmesis, reduced post-operative pain, less blood loss with fewer blood transfusions, fewer infections, shorter length of stay, and faster return to activity. It is our standard of care approach for mitral valve surgery.
20世纪90年代，其他外科亚专业中“微创”腹腔镜手术的成功引发了人们对心脏手术微创方法的兴趣，特别是二尖瓣修复手术。1996年，在纽约大学（NYU），我们在一项I期临床试验中开始了通过小右前微创胸廓切开术切口使用Port-Access系统进行微创二尖瓣修复的经验。这是我们在纽约大学进行二尖瓣修复的广泛右微创胸廓切开术经验的开端。目前在我们机构，右微创胸廓切开术二尖瓣手术的首选方法是通过第3或第4肋间微创胸廓切开术切口。通过直接主动脉或股动脉插管、长股静脉插管引流以及在经食管超声心动图（TEE）引导下经心房将逆行心脏停搏导管置于冠状窦来实现灌注。在前升主动脉中放置顺行心脏停搏和排气针，并使用几种专门的交叉夹之一实现直接体外主动脉钳夹。凭借四十多年的经验，纽约大学已有超过4000例患者接受了二尖瓣修复手术，其中1922例是通过右微创胸廓切开术进行的。我们报告了我们最初的1071例右微创胸廓切开术二尖瓣修复系列的总体手术死亡率为1.3%，8年免于再次手术率为95%，免于再次手术或严重复发性二尖瓣反流率为93%，以及免于所有瓣膜相关并发症率为90%。基于我们的广泛经验，我们认为通过右微创胸廓切开术进行二尖瓣修复为传统胸骨切开术提供了一种持久且安全的替代方法，具有改善美容效果、减轻术后疼痛、减少失血和输血次数、减少感染、缩短住院时间以及更快恢复活动的益处。这是我们二尖瓣手术的标准治疗方法。
