Akowuah Enoch, Burdett Clare, Khan Khalid, Goodwin Andrew, Lage Ignacio Bibiloni, El-Saegh Mohamed, Smailes Tracey, Hunter Steven
J Heart Valve Dis. 2015 Jul;24(4):470-7.
The practice of thoracoscopic assisted minimally invasive mitral valve repair surgery is less common in the United Kingdom than in Europe or the USA. The main reasons for this are concerns around increased operative risk, feasibility and durability of valve repair. The study aim was to report the early and late outcomes of minimally invasive mitral valve repair surgery at a single U.K. center.
Patients undergoing isolated minimally invasive mitral valve repair between 2003 and 2013 were reviewed retrospectively. Data were obtained from a prospectively maintained institutional database, a comprehensive review of individual case notes, echocardiograms, intensive care charts, clinic letters, discharge summaries, and the authors' follow up database (based on data supplied by the UK Office for National Statistics).
A total of 190 patients (mean age 61 years; mean EuroSCORE 3.9) underwent the procedure. The mean cardiopulmonary bypass and aortic cross-clamp times were 153 and 108 min, respectively. Rates of major postoperative complications were: reoperation for bleeding 3.7%, stroke 1.6%, intra-aortic balloon pump 2.1%, and venovenous hemofiltration 2.6%. The median intensive care stay was one day, and the median hospital stay five days (21.8% of patients were discharged by day 3). The 30-day mortality was 1.1% (n = 2). Echocardiography performed at discharge or six weeks postoperatively showed less than mild mitral regurgitation (MR) in 91.3%. The median duration of follow up was 57 months. During the entire follow up period, four patients (2.1%) underwent repeat surgery for recurrent MR (between 15 months and five years). Of 188 patients discharged from hospital, nine (4.8%) died during follow up: median 5.3 years (range 1.3- 10.7 years) post surgery.
These data are the first from the U.K. demonstrating early and late outcomes after thoracoscopic assisted minimally invasive mitral valve repair surgery. The data establish the safety and efficacy of the technique and, importantly, lend further support towards a prospective randomized comparison of minimally invasive versus conventional mitral valve repair surgery.
在英国，胸腔镜辅助微创二尖瓣修复手术的应用不如在欧洲或美国普遍。主要原因是人们担心手术风险增加、瓣膜修复的可行性和耐久性。本研究的目的是报告英国一家中心微创二尖瓣修复手术的早期和晚期结果。
回顾性分析2003年至2013年间接受单纯微创二尖瓣修复手术的患者。数据来自前瞻性维护的机构数据库、对个体病例记录的全面回顾、超声心动图、重症监护记录、临床信件、出院小结以及作者的随访数据库（基于英国国家统计局提供的数据）。
共有190例患者（平均年龄61岁；平均欧洲心脏手术风险评估系统评分为3.9）接受了该手术。平均体外循环时间和主动脉阻断时间分别为153分钟和108分钟。术后主要并发症发生率为：因出血再次手术3.7%，中风1.6%，主动脉内球囊反搏2.1%，静脉-静脉血液滤过2.6%。重症监护病房的中位住院时间为1天，医院中位住院时间为5天（21.8%的患者在第3天出院）。30天死亡率为1.1%（n = 2）。出院时或术后6周进行的超声心动图显示，91.3%的患者二尖瓣反流（MR）小于轻度。中位随访时间为57个月。在整个随访期间，4例患者（2.1%）因复发性MR接受了再次手术（在15个月至5年之间）。188例出院患者中，9例（4.8%）在随访期间死亡：术后中位时间为5.3年（范围为1.3 - 10.7年）。
这些数据是英国首次关于胸腔镜辅助微创二尖瓣修复手术后早期和晚期结果的报道。这些数据证实了该技术的安全性和有效性，重要的是，进一步支持了微创与传统二尖瓣修复手术的前瞻性随机比较。
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