Vallabhajosyula Prashanth, Wallen Tyler, Pulsipher Aaron, Pitkin Emil, Solometo Lauren P, Musthaq Shenara, Fox Jeanne, Acker Michael, Hargrove W Clark
Division of Cardiac Surgery, The University of Pennsylvania Health System, Philadelphia, Pennsylvania.
Division of Cardiac Surgery, The University of Pennsylvania Health System, Philadelphia, Pennsylvania.
Ann Thorac Surg. 2015 Jul;100(1):68-73. doi: 10.1016/j.athoracsur.2015.02.039. Epub 2015 May 12.
In patients requiring a second-time or more operation on the mitral valve (MV), we assessed whether the outcomes of the minimally invasive port access approach (port access group) were equivalent to those of the traditional redo sternotomy approach (redo sternotomy group).
In a retrospective review (1998-2011), 409 patients had previous MV operations requiring a second-time or more MV reintervention. Of those, 67 patients had the port access approach, and 342 had the redo sternotomy approach. Of the latter, 220 met the inclusion criteria because emergencies, patients with endocarditis, and those requiring concomitant procedures involving aortic valve and aorta were excluded.
New York Heart Association class 2 or above, age, atrial fibrillation, and surgical indications were similar in both groups. The port access group had more patients with previous MV repair (78% [n = 52] vs 41% [n = 90], p < 0.01) than with MV replacement (19% [n = 13) vs 53% [n = 116], p < 0.01). Concomitant procedures were similar (20% [n = 14] vs 27% [n = 59], p = 0.4). The MV re-repair rates were similar (19% [n = 10] vs 22% [n = 20], p = 1). The cardiopulmonary bypass times (153 ± 42 minutes vs 172 ± 83 minutes, p = 0.07) and aortic cross-clamping times (104 ± 38 minutes versus 130 ± 71 minutes, p < 0.01) were lower in the port access group. Mortality was lower in the port access group, although not significantly (3.0% [n = 2] vs 6.0% [n = 13], p = 0.5). The rates of postoperative stroke were similar (3.0% [n = 2] vs 3.2% [n = 7], p = 1). On postoperative echocardiography, freedom from mitral regurgitation >2+ was 100% in the port access group and 99% in the redo sternotomy group. The mean hospital length of stay was 11 ± 15 days versus 14 ± 12 days (p = 0.07).
The port access approach can be safely adopted for reoperations on the MV without compromising postoperative mortality or MV function.
在需要对二尖瓣（MV）进行二次或更多次手术的患者中，我们评估了微创端口入路手术（端口入路组）的结果是否等同于传统的再次胸骨切开术（再次胸骨切开术组）。
在一项回顾性研究（1998 - 2011年）中，409例患者曾接受过MV手术，需要进行二次或更多次MV再次干预。其中，67例患者采用端口入路手术，342例患者采用再次胸骨切开术。在后者中，220例符合纳入标准，因为排除了急诊患者、心内膜炎患者以及需要同时进行涉及主动脉瓣和主动脉手术的患者。
两组患者的纽约心脏协会心功能分级2级或以上、年龄、心房颤动和手术指征相似。端口入路组中既往接受MV修复的患者比接受MV置换的患者更多（78% [n = 52] 对41% [n = 90]，p < 0.01）（19% [n = 13] 对53% [n = 116]，p < 0.01）。同期手术相似（20% [n = 14] 对27% [n = 59]，p = 0.4）。MV再次修复率相似（19% [n = 10] 对22% [n = 20]，p = 1）。端口入路组的体外循环时间（153 ± 42分钟对172 ± 83分钟，p = 0.07）和主动脉阻断时间（104 ± 38分钟对130 ± 71分钟，p < 0.01）更低。端口入路组的死亡率更低，尽管差异不显著（3.0% [n = 2] 对6.0% [n = 13]，p = 0.5）。术后中风发生率相似（3.0% [n = 2] 对3.2% [n = 7]，p = 1）。术后超声心动图检查显示，端口入路组二尖瓣反流>2+的发生率为100%，再次胸骨切开术组为99%。平均住院时间为11 ± 15天对14 ± 12天（p = 0.07）。
对于MV再次手术，可安全采用端口入路手术，且不影响术后死亡率或MV功能。
