Gilmanov Daniyar, Solinas Marco, Farneti Pier Andrea, Cerillo Alfredo Giuseppe, Kallushi Enkel, Santarelli Filippo, Glauber Mattia
Department of Adult Cardiac Surgery, Gabriele Monasterio Tuscany Foundation, G. Pasquinucci Heart hospital, Massa, MS 54100, Italy.
Ann Cardiothorac Surg. 2015 Mar;4(2):160-9. doi: 10.3978/j.issn.2225-319X.2014.12.05.
This study reports the single center experience on minimally invasive aortic valve replacement (MIAVR), performed through a right anterior minithoracotomy or ministernotomy (MS).
Eight hundred and fifty-three patients, who underwent MIAVR from 2002 to 2014, were retrospectively analyzed. Survival was evaluated using the Kaplan-Meier method. The Cox multivariable proportional hazards regression model was developed to identify independent predictors of follow-up mortality.
Median age was 73.8, and 405 (47.5%) of patients were female. The overall 30-day mortality was 1.9%. Four hundred and forty-three (51.9%) and 368 (43.1%) patients received biological and sutureless prostheses, respectively. Median cardiopulmonary bypass time and aortic cross-clamping time were 108 and 75 minutes, respectively. Nineteen (2.2%) cases required conversion to full median sternotomy. Thirty-seven (4.3%) patients required re-exploration for bleeding. Perioperative stroke occurred in 15 (1.8%) patients, while transient ischemic attack occurred postoperative in 11 (1.3%). New onset atrial fibrillation was reported for 243 (28.5%) patients. After a median follow-up of 29.1 months (2,676.0 patient-years), survival rates at 1 and 5 years were 96%±1% and 80%±3%, respectively. Cox multivariable analysis showed that advanced age, history of cardiac arrhythmia, preoperative chronic renal failure, MS approach, prolonged mechanical ventilation and hospital stay as well as wound revision were associated with higher mortality.
MIAVR via both approaches is safe and feasible with excellent outcomes, and is associated with low conversion rate and low perioperative morbidity. Long term survival is at least comparable to that reported for conventional sternotomy AVR.
本研究报告了通过右前小切口开胸或微创胸骨切开术（MS）进行微创主动脉瓣置换术（MIAVR）的单中心经验。
回顾性分析了2002年至2014年接受MIAVR的853例患者。采用Kaplan-Meier法评估生存率。建立Cox多变量比例风险回归模型以确定随访死亡率的独立预测因素。
中位年龄为73.8岁，405例（47.5%）患者为女性。总体30天死亡率为1.9%。分别有443例（51.9%）和368例（43.1%）患者接受了生物瓣膜和无缝线瓣膜假体。中位体外循环时间和主动脉阻断时间分别为108分钟和75分钟。19例（2.2%）病例需要转为全胸骨正中切开术。37例（4.3%）患者因出血需要再次手术探查。围手术期卒中发生在15例（1.8%）患者中，而术后短暂性脑缺血发作发生在11例（1.3%）患者中。243例（28.5%）患者报告新发房颤。中位随访29.1个月（2676.0患者年）后，1年和5年生存率分别为96%±1%和80%±3%。Cox多变量分析显示，高龄、心律失常病史、术前慢性肾功能衰竭、MS入路、机械通气和住院时间延长以及伤口修复与较高的死亡率相关。
两种入路的MIAVR安全可行，效果良好，转换率低，围手术期发病率低。长期生存率至少与传统胸骨切开术主动脉瓣置换术报告的生存率相当。
