Lan H, Cheng Y G, Jia B C, Chai Y L
Department of Thoracoscopic Cardiacsurgery, Shanghai Yodak Cardiothoracic Hospital, Shanghai 200235, China.
Zhonghua Wai Ke Za Zhi. 2016 Aug 1;54(8):609-12. doi: 10.3760/cma.j.issn.0529-5815.2016.08.011.
To summarize the clinical outcome of totally thoracoscopic cardiac surgery for mitral valve replacement.
Clinical data of 634 cases undergoing totally thoracoscopic cardiac surgery for mitral valve replacement from May 2004 to February 2016 in Department of Thoracoscopic Cardiacsurgery, Shanghai Yodak Cardiothoracic Hospital was analyzed retrospectively. There were 292 male and 342 female patients, aged from 17 to 68 years with a mean of (45±13) years. All the 634 patients had moderate-severe mitral valve stenosis and (or) incompetence, 263 patients had moderate-severe tricuspid valve incompetence, 356 patients had atrial fibrillation, 46 patients had left atrium thrombosis. Cardiopulmonary bypass was established with right femoral artery and a single 2 stage venus cannula in the right atrium. The ascending aorta was cross-clamped and the myocardium was protected by coronary perfusion with cold crystalloid cardioplegia. Totally thoracoscopic mitral valve replacement were performed.
Thirteen cases had incision expanded and 8 cases had conversions to sternotomy. Cardiopulmonary bypass and aortic cross-clamp time were (89±18) minutes and (51±12) minutes, respectively. Operation time was (3.1±1.2) hours. Mechanical ventilation time and intensive care unit stay were (17±6) hours and (27±8) hours, respectively. Postoperation drainage quantity was (390±70) ml. The hospital days was (9.2±2.1) days. There were 5 cases in-hospital deaths. Postoperative complications occurred in 42 cases (6.6%), including 18 cases of right hemoneumothorax, 12 cases of reoperation for bleeding, 3 cases of perivalvular leakage (reoperation was done in 1 patient), 3 cases of low cardiac output syndrome, 2 cases of acute renal failure, 2 cases of inferior vena cava injury, 1 case of right femoral artery thrombosis and liver injury, respectively. The mean duration of follow-up was (58±9) months in 608 cases, with a follow-up rate of 96.7% (608/629). Three patients had died during the period of follow-up caused by congestive heart failure (2 patients) and stroke (1 patient). Late complication among 605 survivors were 37 cases, including 32 cases of moderate tricuspid valve insufficiency, 3 cases of stroke, 1 case of perivalvular leakage and infective endocarditis, respectively.There was no reoperation during the period of follow-up.
Totally thoracoscopic cardiac surgery for mitral valve replacement is safe and effective, with unique superiority and clinical feasible.
总结全胸腔镜二尖瓣置换术的临床疗效。
回顾性分析2004年5月至2016年2月在上海远大心胸医院胸腔镜心脏外科接受全胸腔镜二尖瓣置换术的634例患者的临床资料。其中男性292例，女性342例，年龄17～68岁，平均（45±13）岁。634例患者均有中重度二尖瓣狭窄和（或）关闭不全，263例有中重度三尖瓣关闭不全，356例有房颤，46例有左心房血栓形成。采用右股动脉和右心房单根二级静脉插管建立体外循环。升主动脉阻断，经冠状动脉灌注冷晶体停搏液保护心肌。行全胸腔镜二尖瓣置换术。
13例切口扩大，8例中转开胸。体外循环时间和主动脉阻断时间分别为（89±18）分钟和（51±12）分钟。手术时间为（3.1±1.2）小时。机械通气时间和重症监护病房停留时间分别为（17±6）小时和（27±8）小时。术后引流量为（390±70）ml。住院天数为（9.2±2.1）天。住院死亡5例。术后并发症42例（6.6%），其中右侧血胸18例，再次手术止血12例，瓣周漏3例（1例再次手术），低心排综合征3例，急性肾衰竭2例，下腔静脉损伤2例，右股动脉血栓形成和肝损伤各1例。608例患者平均随访时间为（58±9）个月，随访率为96.7%（608/629）。随访期间3例患者因充血性心力衰竭（2例）和中风（1例）死亡。605例存活患者的晚期并发症37例，其中中重度三尖瓣关闭不全32例，中风3例，瓣周漏和感染性心内膜炎各1例。随访期间无再次手术病例。
全胸腔镜二尖瓣置换术安全有效，具有独特优势，临床可行。
