经右前小切口和主动脉中心插管行微创主动脉瓣置换术：13年经验
Minimally Invasive Aortic Valve Replacement via Right Anterior Minithoracotomy and Central Aortic Cannulation: A 13-Year Experience.
作者信息
Bethencourt Daniel M, Le Jennifer, Rodriguez Gabriela, Kalayjian Robert W, Thomas Gregory S
机构信息
From the *MemorialCare Heart & Vascular Institute at Long Beach Memorial, Long Beach, CA USA; †Orange Coast Memorial, Fountain Valley, CA USA; ‡University of California San Diego, Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, CA USA; and §Division of Cardiology, University of California Irvine, CA USA.
出版信息
Innovations (Phila). 2017 Mar/Apr;12(2):87-94. doi: 10.1097/IMI.0000000000000358.
OBJECTIVE
This study reports the evolution of a minimally invasive aortic valve replacement (mini-AVR) technique that uses a right anterior minithoracotomy approach with central cannulation, for a 13-year period. This technique has become our standard approach for isolated primary AVR in nearly all patients.
METHODS
This observational study evaluated perioperative clinical outcomes of patients 18 years or older who underwent mini-AVR from November 2003 to June 2015.
RESULTS
The mini-AVR technique was used in 202 patients during two periods of 2003 to 2009 (n = 65, "early") and 2010 to 2015 (n = 137, "late"). The mean ± SD age was 72.5 ± 12.9 years and 60% were male. Demographic parameters were statistically similar between the study periods, except for increased body weight in the later period (75.3 ± 14.7 vs 80.9 ± 20.8 kg, P = 0.03). The mean cardiopulmonary bypass and aortic cross-clamp times were significantly different by each year and Bonferroni adjustment, with significant decreases in cardiopulmonary bypass and aortic cross-clamp times beginning 2006. Compared with the early study period, late study period patients were more often extubated intraoperatively (52% vs 12%, P < 0.001), had less frequent prolonged ventilator use postoperatively (6% vs 16%, P = 0.018), required fewer blood transfusions (mean, 2.0 ± 2.3 U vs 3.6 ± 3.0 U; P = 0.011), and had shorter postoperative stay (6.3 ± 4.5 days vs 8.0 ± 5.9 days, P = 0.026). Numerically, fewer postoperative strokes (1% vs 6%, P = 0.09) and fewer reoperations for bleeding (3% vs 6%, P = 0.3) occurred in the late period. In-hospital mortality did not differ (1/65 early vs 3/137 late).
CONCLUSIONS
Overall mini-AVR intraoperative and postoperative clinical outcomes improved for this 13-year experience.
目的
本研究报告了一种微创主动脉瓣置换术（mini-AVR）技术在13年期间的发展情况，该技术采用右前小切口开胸入路并进行中心插管。在几乎所有患者中，这项技术已成为我们孤立性原发性主动脉瓣置换术的标准入路。
方法
这项观察性研究评估了2003年11月至2015年6月期间接受mini-AVR的18岁及以上患者的围手术期临床结局。
结果
在2003年至2009年（n = 65，“早期”）和2010年至2015年（n = 137，“晚期”）这两个时间段内，共有202例患者接受了mini-AVR。平均年龄±标准差为72.5±12.9岁，60%为男性。除后期体重增加外（75.3±14.7 vs 80.9±20.8 kg，P = 0.03），两个研究时间段的人口统计学参数在统计学上相似。每年和经Bonferroni校正后，平均体外循环时间和主动脉阻断时间有显著差异，自2006年起体外循环时间和主动脉阻断时间显著缩短。与早期研究时间段相比，后期研究时间段的患者术中拔管更为常见（52% vs 12%，P < 0.001），术后呼吸机使用时间延长的频率更低（6% vs 16%，P = 0.018），输血需求更少（平均，2.0±2.3 U vs 3.6±3.0 U；P = 0.011），术后住院时间更短（6.3±4.5天 vs 8.0±5.9天，P = 0.026）。在数量上，后期术后中风（1% vs 6%，P = 0.09）和因出血再次手术的情况（3% vs 6%，P = 0.3）较少。住院死亡率无差异（早期1/65 vs 晚期3/137）。
结论
在这13年的经验中，总体mini-AVR术中及术后临床结局有所改善。
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