Department of Cardiovascular and Thoracic Surgery, Città della Salute e della Scienza - San Giovanni Battista Hospital "Molinette", Turin, Italy.
Department of Cardiac Surgery, Klinikum Dortmund, Dortmund, Germany.
Ann Thorac Surg. 2018 Mar;105(3):794-798. doi: 10.1016/j.athoracsur.2017.09.054. Epub 2017 Dec 28.
Less-invasive mitral valve surgery has become a widespread procedure in recent years, although mode of perfusion and aortic clamping are still debated questions. The aim of this study was to compare the results between transthoracic aortic clamping (TTC) and endoaortic clamping (EAC) in a multicenter, retrospective study.
Data from 3 centers experienced in both TTC and EAC were retrospectively analyzed. Five hundred consecutive patients undergoing less-invasive mitral valve surgery received either TTC (n = 250) or EAC (n = 250). Age, sex, logistic EuroSCORE, ejection fraction, associated procedures, and mitral valve repair rate were similar. A higher incidence of previous cardiac operations was observed in the EAC group (TTC 8.8% versus EAC 16.8%, p = 0.001).
Clamping and cardiopulmonary bypass times were comparable between the 2 groups. Reoperation for bleeding (TTC 11.2% versus EAC 3.2%, p < 0.001), conversion to full sternotomy (6 cases in the TTC group), and hospital length of stay (TTC 9 days versus EAC 8 days, p = 0.01) were higher in the TTC group. No differences were found in respiratory failure, renal failure, major vascular complication, stroke, and in-hospital mortality rate.
Despite recent concerns arising about EAC, this large multicenter study shows equivalence in terms of safety and effectiveness of this technique compared with TTC. Reduction in postoperative bleeding was observed in the EAC group despite the higher rate of complex redo cases.
近年来，微创二尖瓣手术已广泛开展，但关于灌注方式和主动脉阻断的选择仍存在争议。本研究旨在通过多中心回顾性研究比较经胸主动脉阻断（TTC）和经主动脉内阻断（EAC）的结果。
对 3 个中心的 TTC 和 EAC 经验数据进行回顾性分析。500 例接受微创二尖瓣手术的患者接受 TTC（n=250）或 EAC（n=250）。年龄、性别、逻辑 EuroSCORE、射血分数、合并手术和二尖瓣修复率相似。EAC 组有更多的既往心脏手术史（TTC 8.8% vs EAC 16.8%，p=0.001）。
两组的阻断和体外循环时间相似。TTC 组的再手术出血率（11.2% vs EAC 3.2%，p<0.001）、转为全胸骨切开术（TTC 组 6 例）和住院时间（TTC 9 天 vs EAC 8 天，p=0.01）更高。TTC 组呼吸衰竭、肾衰竭、大血管并发症、卒中和住院死亡率无差异。
尽管最近对 EAC 有担忧，但这项大型多中心研究表明，与 TTC 相比，该技术在安全性和有效性方面是等效的。尽管复杂的再次手术率较高，但 EAC 组术后出血减少。
