利用心脏端口技术的微创二尖瓣手术。

Minimally invasive mitral valve surgery utilizing heart port technology.

作者信息

Vallabhajosyula Prashanth, Wallen Tyler J, Solometo Lauren P, Fox Jeanne, Vernick William J, Hargrove W Clark

机构信息

Department of Cardiac Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania.

出版信息

J Card Surg. 2014 May;29(3):343-8. doi: 10.1111/jocs.12293. Epub 2014 Feb 4.

DOI:10.1111/jocs.12293

PMID:24495015

Abstract

OBJECTIVE

To determine operative outcomes of right mini-thoracotomy mitral valve surgery utilizing port access technology in first-time and reoperative cardiac surgery patients.

METHODS

From 2002 to 2011, 881 patients underwent minimally invasive mitral valve surgery. Of these, 154 patients had previous cardiac operations via sternotomy (Group 1), of which 18 (12%) had two previous operations. Seven hundred and twenty-seven patients had no previous cardiac operations (Group 2).

RESULTS

Patient demographics were similar in both groups. In Group 1, 76 (49%) patients had previous coronary artery bypass grafting, 13 (8%) had previous aortic valve surgery, and 57 (37%) had previous mitral valve surgery. Preoperative echo findings for Groups 1 and 2 included severe mitral regurgitation (MR) (88%, n = 135; 94%, n = 687), mitral stenosis (MS) (4%, n = 6; 2%, n = 12), MS + MR (8%, n = 13; 4%, n = 28), and ejection fraction (48%, 56%). Operative procedures in Groups 1 and 2 were MV repair (54%, n = 84; 89%, n = 645) and MV replacement (46%, n = 70; 11%, n = 82). Circulatory management techniques for Groups 1 and 2 included endoballoon (75%, n = 116; 79%, n = 576), Chitwood clamp (8%, n = 12; 20%, n = 147), and fibrillatory arrest (17%, n = 30; 0.5%, n = 4). Perioperative outcomes were: stroke: 2.5%, 1.6%; reoperation for bleeding: 5%, 6%; valvular reoperation rate: 0.6%, 2%; aortic dissection: 2.5%, 1%; and wound infection: 0%, 0%. Transfusion requirement was 49% (n = 76) and 31% (n = 232), respectively. Median hospital stay was seven and seven days, respectively. On postoperative echocardiography, 98% (n = 151) and 99% (n = 718) of patients had zero or trace MR (1+) with 100% freedom from MR > 2+. In-hospital mortality was 3% (n = 5) and 1% (n = 8).

CONCLUSIONS

Operative outcomes with minimally invasive mitral valve surgery utilizing port access technology can be performed safely. Stroke rate was higher in the reoperative cases (p = NS) although similar to reports evaluating redo sternotomy in mitral valve cases.

摘要

目的

确定在初次及再次心脏手术患者中，采用端口入路技术行右胸小切口二尖瓣手术的手术效果。

方法

2002年至2011年，881例患者接受了微创二尖瓣手术。其中，154例患者曾接受过胸骨正中切开术的心脏手术（第1组），其中18例（12%）曾接受过两次手术。727例患者未曾接受过心脏手术（第2组）。

结果

两组患者的人口统计学特征相似。在第1组中，76例（49%）患者曾接受过冠状动脉旁路移植术，13例（8%）曾接受过主动脉瓣手术，57例（37%）曾接受过二尖瓣手术。第1组和第2组术前超声心动图检查结果包括重度二尖瓣反流（MR）（88%，n = 135；94%，n = 687）、二尖瓣狭窄（MS）（4%，n = 6；2%，n = 12）、MS + MR（8%，n = 13；4%，n = 28）以及射血分数（48%，56%）。第1组和第2组的手术方式为二尖瓣修复（54%，n = 84；89%，n = 645）和二尖瓣置换（46%，n = 70；11%，n = 82）。第1组和第2组的循环管理技术包括球囊阻断（75%，n = 116；79%，n = 576）、奇伍德钳夹（8%，n = 12；20%，n = 147）以及纤维蛋白溶解停搏（17%，n = 30；0.5%，n = 4）。围手术期结果如下：卒中：2.5%，1.6%；因出血再次手术：5%，6%；瓣膜再次手术率：0.6%，2%；主动脉夹层：2.5%，1%；以及伤口感染：0%，0%。输血需求分别为49%（n = 76）和31%（n = 232）。中位住院时间分别为7天和7天。术后超声心动图检查显示，98%（n = 151）和99%（n = 718）的患者二尖瓣反流为零或微量（1+），100%的患者二尖瓣反流>2+。住院死亡率分别为3%（n = 5）和1%（n = 8）。