Zhai Junyu, Wei Lai, Huang Ben, Wang Chunsheng, Zhang Hongqiang, Yin Kanhua
Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital Fudan University, Shanghai, China.
Medicine (Baltimore). 2017 Jun;96(24):e7193. doi: 10.1097/MD.0000000000007193.
The aim of the study was to evaluate the treatment of minimally invasive mitral valve replacement (MIMVR) through a right minithoracotomy for patients with rheumatic mitral valve disease.From February 2009 to December 2016, 360 patients with rheumatic mitral valve disease underwent mitral valve replacement by the same surgeon. Among them, 150 patients accepted MIMVR through a right minithoracotomy, whereas the other 210 accepted a traditional median sternotomy. After matching by patients by age, sex, EuroSCORE, New York Heart Association (NYHA) classification, renal and liver function, and degree of mitral valve disease, we selected 224 patients for analysis in our retrospective study.In the MIMVR group (112 patients), the aortic cross-clamp time (ACC time) (55.25 ± 2.18 minutes) was significantly longer than that in the control group (112 patients; 36.05 ± 1.40 minutes) (P < .0001). In contrast, the cardiopulmonary bypass time (CPB time) was shorter in the MIMVR group than in the control group (61.13 ± 2.57 vs 78.65 ± 4.05 minutes, respectively, P < .0001). Patients who accepted MIMVR surgery had less drainage 24 hours postoperation (324.10 ± 34.55 vs 492.90 ± 34.05 mL, P < .0001) and had less total drainage (713.46 ± 65.35 vs 990.49 ± 67.88 mL, P < .0001) than those who underwent median sternotomy. Thirty-two percent of patients in the MIMVR group needed a blood transfusion (1.35 ± .28 units of red blood cells, 155.36 ± 33.43 mL plasma), whereas 67.0% of the control group needed a blood transfusion (2.15 ± .24 units of red blood cells, 287.50 ± 33.54 mL plasma) (Ptransfusion < .001, Pcell = .029, Pplasma = .006). In total, 5 deaths occurred during the perioperative period; 3 occurred in the MIMVR group. The average hospital stay was significantly shorter in the MIMVR group than that in the control group (6.56 ± .23 vs 8.53 ± .59 days, P = .003).MIMVR, an effective and safe treatment approach for patients suffering from rheumatic mitral valve disease, is associated with less trauma and a faster recovery. It is a better choice for treating simple rheumatic mitral valve disease.
本研究的目的是评估经右胸小切口对风湿性二尖瓣疾病患者进行微创二尖瓣置换术（MIMVR）的治疗效果。2009年2月至2016年12月，360例风湿性二尖瓣疾病患者由同一位外科医生进行二尖瓣置换术。其中，150例患者接受经右胸小切口的MIMVR，而另外210例接受传统正中开胸手术。在按年龄、性别、欧洲心脏手术风险评估系统（EuroSCORE）、纽约心脏协会（NYHA）分级、肝肾功能及二尖瓣疾病程度对患者进行匹配后，我们选取224例患者进行回顾性研究分析。在MIMVR组（112例患者）中，主动脉阻断时间（ACC时间）（55.25±2.18分钟）显著长于对照组（112例患者；36.05±1.40分钟）（P<0.0001）。相反，MIMVR组的体外循环时间（CPB时间）短于对照组（分别为61.13±2.57分钟和78.65±4.05分钟，P<0.0001）。接受MIMVR手术的患者术后24小时引流量较少（324.10±34.55毫升对492.90±34.05毫升，P<0.0001），总引流量也较少（713.46±65.35毫升对990.49±67.88毫升，P<0.0001），低于接受正中开胸手术的患者。MIMVR组32%的患者需要输血（1.35±0.28单位红细胞，155.36±33.43毫升血浆），而对照组67.0%的患者需要输血（2.15±0.24单位红细胞，287.50±33.54毫升血浆）（输血P<0.001，红细胞P=0.029，血浆P=0.006）。围手术期共发生5例死亡；3例发生在MIMVR组。MIMVR组的平均住院时间显著短于对照组（6.56±0.23天对8.53±0.59天，P=0.003）。MIMVR是治疗风湿性二尖瓣疾病患者的一种有效且安全的治疗方法，具有创伤小、恢复快的特点。它是治疗单纯风湿性二尖瓣疾病的更佳选择。
