Risteski Petar, Monsefi Nadejda, Miskovic Aleksandra, Josic Tanja, Bala Sherife, Salem Razan, Zierer Andreas, Moritz Anton
Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University Hospital, Frankfurt am Main, Germany.
Interact Cardiovasc Thorac Surg. 2017 May 1;24(5):677-682. doi: 10.1093/icvts/ivw430.
A partial upper sternotomy has become established as a less invasive approach mainly for single and double valve surgery. This report evaluates the clinical outcomes of triple valve surgery performed through a partial upper sternotomy.
We reviewed the medical records of 37 consecutive patients (28 men, 76%) who underwent triple valve surgery through a partial upper sternotomy between 2005 and 2015. The patients' mean age was 67 ± 17 years; 27 (73%) were in New York Heart Association Class III or IV. Aortic and mitral valve insufficiency was more common than stenosis. Ninety-three percent of surviving patients were followed for a mean period of 58 ± 24 months.
Aortic valve procedures consisted of 24 (65%) replacements and 13 (35%) repairs. The mitral valve was repaired in 28 (76%) patients, whereas tricuspid valve repair was feasible in all patients. No conversion to full sternotomy was necessary. Myocardial infarction was not observed. Chest tube drainage was 330 ± 190 ml, and 4 patients required reopening for bleeding (1, 3%) or tamponade (3, 8%). One stroke was observed due to heparin-induced thrombocytopaenia after initial unremarkable neurological recovery. Early mortality included 5 (13.5%) patients. Actuarial survival at 5 years was 52 ± 10%.
A partial upper sternotomy provides adequate exposure to all heart valves. We did not experience technical limitations with this approach. Wound dehiscence, postoperative bleeding, intensive care unit and hospital stay and early deaths were low compared to data from other published series of triple valve surgery through a full median sternotomy. Early and mid-term outcomes were not adversely affected by this less invasive approach.
部分上胸骨切开术已成为一种主要用于单瓣膜和双瓣膜手术的侵入性较小的方法。本报告评估了通过部分上胸骨切开术进行三瓣膜手术的临床结果。
我们回顾了2005年至2015年间连续37例通过部分上胸骨切开术进行三瓣膜手术患者的病历。患者的平均年龄为67±17岁；27例（73%）为纽约心脏协会III或IV级。主动脉瓣和二尖瓣关闭不全比狭窄更常见。93%的存活患者平均随访58±24个月。
主动脉瓣手术包括24例（65%）置换和13例（35%）修复。28例（76%）患者的二尖瓣得到修复，而所有患者的三尖瓣修复均可行。无需转为全胸骨切开术。未观察到心肌梗死。胸腔闭式引流量为330±190ml，4例患者因出血（1例，3%）或心包填塞（3例，8%）需要再次手术。最初神经功能恢复正常后，因肝素诱导的血小板减少症观察到1例中风。早期死亡率包括5例（13.5%）患者。5年精算生存率为52±10%。
部分上胸骨切开术可充分暴露所有心脏瓣膜。我们在这种方法上没有遇到技术限制。与其他已发表的通过全正中胸骨切开术进行三瓣膜手术系列的数据相比，伤口裂开、术后出血、重症监护病房和住院时间以及早期死亡率较低。这种侵入性较小的方法对早期和中期结果没有不利影响。
