Fattouch Khalil, Moscarelli Marco, Del Giglio Mauro, Albertini Alberto, Comoglio Chiara, Coppola Roberto, Nasso Giuseppe, Speziale Giuseppe
Department of Surgery and Cancer, University of Palermo, Italy Department of Cardiothoracic and vascular Surgery, GVM Care and Research, Villa Maria Eleonora, Palermo, Italy.
National Heart and Lung Institute, Imperial College, London, UK
Interact Cardiovasc Thorac Surg. 2016 Aug;23(2):253-8. doi: 10.1093/icvts/ivw104. Epub 2016 May 8.
Aortic valve replacement through conventional sternotomy still represents the gold-standard surgical approach for aortic valve disease. However, given the increasing number of patients with comorbidities, strategies that can improve operative results are always sought. Minimally invasive aortic valve surgery, although related to a steep learning curve, might be associated with improved postoperative outcomes. The main aim of this study was to assess whether significant differences exist in terms of operative and early results between a mini-sternotomy and a right mini-thoracotomy approach for isolated aortic valve replacement without sutureless technologies.
This is an observational retrospective multicentre study from nine Italian cardiac centres that analyses prospectively collected data of patients who underwent isolated minimally invasive aortic valve replacement between January 2010 and December 2014. Two approaches are considered (mini-sternotomy and mini-thoracotomy) and compared in terms of operative and early outcomes.
After interrogation of the centralized database, a total of 1130 patients were retrieved (854 mini-sternotomy and 276 mini-thoracotomy). Patients in the mini-sternotomy group had a higher risk profile. There was no difference in terms of early mortality; cardiopulmonary bypass and cross-clamp time did not differ significantly between the groups; and a significantly higher number of reoperations for bleeding was observed in the right mini-thoracotomy group.
Both mini-sternotomy and mini-thoracotomy could be performed safely, with low mortality and postoperative morbidity. The mini-thoracotomy approach was associated with a significantly higher rate of reoperation for bleeding. Uptake among cardiac centres was low. Sutureless technologies could potentially increase surgical volume by simplifying the mini-thoracotomy procedure.
经传统胸骨切开术进行主动脉瓣置换术仍是治疗主动脉瓣疾病的金标准手术方法。然而，鉴于合并症患者数量不断增加，人们一直在寻求能够改善手术效果的策略。微创主动脉瓣手术尽管学习曲线较陡，但可能会改善术后结果。本研究的主要目的是评估在不使用无缝合技术的情况下，对于单纯主动脉瓣置换术，正中胸骨小切口与右胸小切口手术方法在手术及早期结果方面是否存在显著差异。
这是一项来自意大利九个心脏中心的观察性回顾性多中心研究，分析了2010年1月至2014年12月期间接受单纯微创主动脉瓣置换术患者的前瞻性收集数据。考虑了两种手术方法（正中胸骨小切口和右胸小切口），并比较了手术及早期结果。
查询集中数据库后，共检索到1130例患者（854例行正中胸骨小切口手术，276例行右胸小切口手术）。正中胸骨小切口组患者的风险特征更高。早期死亡率无差异；两组之间体外循环和主动脉阻断时间无显著差异；右胸小切口组因出血再次手术的患者数量明显更多。
正中胸骨小切口和右胸小切口手术均能安全进行，死亡率和术后发病率较低。右胸小切口手术方法因出血再次手术的发生率明显更高。心脏中心对该手术的接受度较低。无缝合技术可能通过简化右胸小切口手术操作来增加手术量。
