Murzi Michele, Miceli Antonio, Di Stefano Gioia, Cerillo Alfredo G, Farneti Pierandrea, Solinas Marco, Glauber Mattia
Fondazione Toscana Gabriele Monasterio, G. Pasquinucci Heart Hospital, Massa, Italy.
Fondazione Toscana Gabriele Monasterio, G. Pasquinucci Heart Hospital, Massa, Italy.
J Thorac Cardiovasc Surg. 2014 Dec;148(6):2763-8. doi: 10.1016/j.jtcvs.2014.07.108. Epub 2014 Aug 14.
This study presents a review of our experience with minimally invasive mitral valve surgery (MIMVS) in patients with a previous cardiac procedure performed through a sternotomy over a 10-year period.
From November 2003 to August 2013, 173 patients (age 61.3 ± 12.4 years) underwent reoperative MIMVS through a right minithoracotomy. Previous operations were coronary artery bypass grafting (n = 49; 28.6%), a mitral valve procedure (n = 120; 70.1%), an aortic valve procedure (n = 32; 18.7%), and other operations (n = 14; 8.1%). The mean euroSCORE was 11.2 ± 3.8. The time to redo surgery was 6.9 ± 4.2 years.
Procedures were performed with central aortic cannulation in 55 patients (31.7%) and peripheral cannulation in 118 (68.3%). A transthoracic clamp was used in 58 patients (33.5%), an endoaortic balloon in 72 (41.6%), hypothermic ventricular fibrillation in 23 (13.2%), and beating heart in 20 (11.5%). Mean cardiopulmonary bypass and crossclamp times were 160 ± 58 minutes and 82 ± 49 minutes, respectively. Mitral repair was performed in 53 patients (30.6%). Forty-three patients (24.7%) had an additional cardiac procedure. Conversion to sternotomy was necessary in 2 patients (1.1%) and reoperation for bleeding in 11 patients (6.3%). Thirty-day mortality was 4.1% (n = 7). Major morbidities included stroke (n = 11; 6%) and new-onset dialysis requirement (n = 4; 2.3%). The mean blood transfusion requirement was 1.4 ± 1.1 units. Mean follow-up was 3.3 ± 2.6 years. Survival at 1, 5, and 10 years was 93.1% ± 1.9%, 87.5% ± 2.7%, and 79.7% ± 3.8%, respectively.
Reoperative mitral valve surgery can be safely performed through a right minithoracotomy with good early and late outcomes. The avoidance of extensive surgical dissection, optimal valve exposure, and low blood transfusion are the main advantages of this technique.
本研究回顾了我们在10年期间对曾通过胸骨切开术进行过心脏手术的患者实施微创二尖瓣手术（MIMVS）的经验。
2003年11月至2013年8月，173例患者（年龄61.3±12.4岁）通过右胸小切口接受再次手术MIMVS。既往手术包括冠状动脉旁路移植术（n = 49；28.6%）、二尖瓣手术（n = 120；70.1%）、主动脉瓣手术（n = 32；18.7%）和其他手术（n = 14；8.1%）。平均欧洲心脏手术风险评估系统（EuroSCORE）评分为11.2±3.8。再次手术时间为6.9±4.2年。
55例患者（31.7%）采用中心主动脉插管进行手术，118例（68.3%）采用外周插管。58例患者（33.5%）使用了经胸夹，72例（41.6%）使用了主动脉内球囊，23例（13.2%）使用了低温室颤，20例（11.5%）在心脏跳动下进行手术。平均体外循环时间和主动脉阻断时间分别为160±58分钟和82±49分钟。53例患者（30.6%）进行了二尖瓣修复。43例患者（24.7%）进行了额外的心脏手术。2例患者（1.1%）需要转为胸骨切开术，11例患者（6.3%）因出血再次手术。30天死亡率为4.1%（n = 7）。主要并发症包括中风（n = 11；6%）和新发透析需求（n = 4；2.3%）。平均输血量为1.4±1.1单位。平均随访时间为3.3±2.6年。1年、5年和10年生存率分别为93.1%±1.9%、87.5%±2.7%和79.7%±3.8%。
再次二尖瓣手术可通过右胸小切口安全实施，早期和晚期效果良好。避免广泛的手术解剖、优化瓣膜暴露和低输血量是该技术的主要优点。
