Sündermann Simon H, Czerny Martin, Falk Volkmar
Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin (German Heart Institute Berlin), Augustenburgr Platz 1, 13353, Berlin, Germany.
Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.
Cardiovasc Eng Technol. 2015 Jun;6(2):160-6. doi: 10.1007/s13239-015-0210-5. Epub 2015 Jan 21.
Minimally invasive procedures are the standard approach in many centres but are still under debate in regards of inferiority compared to conventional mitral valve surgery through a median sternotomy. The aim of this review was to summarize the current literature comparing minimally invasive mitral valve surgery (MIVS) and conventional mitral valve surgery. In this review of the current literature, we summarize our findings from a recent meta-analysis and add information from papers that were published afterwards. There were no differences between patients treated minimally invasive or through a conventional sternotomy approach in regards of perioperative stroke rate and mortality. Procedural time, cardio-pulmonary-bypass time and cross-clamp time were longer in the MIVS group. In contrast, length of intensive care unit (ICU) stay and length of in hospital stay were significantly reduced in this group. Need for blood transfusion was lower in the MIVS group. Other outcomes like i.e., the rate of rethoracotomies or renal failure didn't differ between the groups. Repair rates and long-term freedom from recurrence of mitral regurgitation and reoperation are similar. Newer publications underline these findings. The current literature shows that MIVS and conventional mitral valve surgery show a similar perioperative outcome. Minimally invasive mitral valve surgery is favourable with regards to ICU stay, in hospital stay as well as need for blood transfusion.
在许多中心,微创手术是标准术式,但与经正中胸骨切开的传统二尖瓣手术相比,其劣势仍存在争议。本综述的目的是总结比较微创二尖瓣手术(MIVS)和传统二尖瓣手术的当前文献。在本次对当前文献的综述中,我们总结了近期一项荟萃分析的结果,并补充了之后发表论文的相关信息。在围手术期卒中发生率和死亡率方面,接受微创治疗或传统胸骨切开术治疗的患者之间没有差异。MIVS组的手术时间、体外循环时间和主动脉阻断时间更长。相比之下,该组的重症监护病房(ICU)住院时间和住院总时长显著缩短。MIVS组的输血需求更低。两组之间的其他结果,如再次开胸率或肾衰竭发生率并无差异。二尖瓣修复率以及二尖瓣反流复发和再次手术的长期无复发生存率相似。最新的出版物也证实了这些发现。当前文献表明,MIVS和传统二尖瓣手术的围手术期结果相似。微创二尖瓣手术在ICU住院时间、住院总时长以及输血需求方面具有优势。