Losenno Katie L, Jones Philip M, Valdis Matthew, Fox Stephanie A, Kiaii Bob, Chu Michael W A
From the Division of Cardiac Surgery, Department of Surgery, Western University, Lawson Health Research Institute, London, Ont., (Losenno, Valdis, Fox, Kiaii, Chu); and the Department of Anesthesia & Perioperative Medicine and Epidemiology & Biostatistics, Western University, London, Ont., (Jones).
Can J Surg. 2016 Dec;59(6):399-406. doi: 10.1503/cjs.004516.
Reoperative mitral valve (MV) surgery is associated with significant morbidity and mortality; however, endoscopic minimally invasive surgical techniques may preserve the surgical benefits of conventional mitral operations while potentially reducing perioperative risk and length of stay (LOS) in hospital.
We compared the outcomes of consecutive patients who underwent reoperative MV surgery between 2000 and 2014 using a minimally invasive endoscopic approach (MINI) with those of patients who underwent a conventional sternotomy (STERN). The primary outcome was in-hospital/30-day mortality. Secondary outcomes included blood product transfusion, LOS in hospital and in the intensive care unit (ICU), and postoperative complications.
We included 132 patients in our study: 40 (mean age 68 ± 14 yr, 70% men) underwent MINI and 92 (62 ± 13 yr, 40% men) underwent STERN. The MINI group had significantly more comorbidities than the STERN group. While there were no significant differences in complications, all point estimates suggested lower mortality and morbidity in the MINI than the STERN group (in-hospital/ 30-day mortality 5% v. 11%, = 0.35; composite any of 10 complications 28% v. 41%, = 0.13). Individual complication rates were similar between the MINI and STERN groups, except for intra-aortic balloon pump requirement (IABP; 0% v. 12%, = 0.034). MINI significantly reduced the need for any blood transfusion (68% v. 84%, = 0.036) or packed red blood cells (63% v. 79%, = 0.042), fresh frozen plasma (35% v. 59%, = 0.012) and platelets (20% v. 40%, = 0.024). It also significantly reduced median hospital LOS (8 v. 12 d, = 0.014). An exploratory propensity score analysis similarly demonstrated a significantly reduced need for IABP ( < 0.001) and a shorter mean LOS in the ICU ( = 0.046) and in hospital ( = 0.047) in the MINI group.
A MINI approach for reoperative MV surgery reduces blood product utilization and hospital LOS. Possible clinically relevant differences in perioperative complications require assessment in randomized clinical trials.
再次二尖瓣（MV）手术与显著的发病率和死亡率相关；然而，内镜微创外科技术可能在保留传统二尖瓣手术益处的同时，潜在地降低围手术期风险和住院时间（LOS）。
我们比较了2000年至2014年间采用微创内镜方法（MINI）进行再次MV手术的连续患者与接受传统胸骨切开术（STERN）患者的结局。主要结局是住院/30天死亡率。次要结局包括血液制品输注、住院和重症监护病房（ICU）的住院时间以及术后并发症。
我们的研究纳入了132例患者：40例（平均年龄68±14岁，70%为男性）接受了MINI手术，92例（62±13岁，40%为男性）接受了STERN手术。MINI组的合并症显著多于STERN组。虽然并发症方面无显著差异，但所有点估计均表明MINI组的死亡率和发病率低于STERN组（住院/30天死亡率5%对11%，P = 0.35；10种并发症中的任何一种的综合发生率28%对41%，P = 0.13）。MINI组和STERN组的个体并发症发生率相似，但主动脉内球囊反搏（IABP）需求情况除外（0%对12%，P = 0.034）。MINI显著降低了任何输血需求（68%对84%，P = 0.036）或浓缩红细胞输注需求（63%对79%，P = 0.042）、新鲜冰冻血浆输注需求（35%对59%，P = 0.012）和血小板输注需求（20%对40%，P = 0.024）。它还显著降低了中位住院LOS（8天对12天，P = 0.014）。一项探索性倾向评分分析同样表明，MINI组IABP需求显著降低（P < 0.001），ICU平均住院时间（P =
