Salman Jawad, Fleißner Felix, Naqizadah Jamshid, Avsar Murat, Shrestha Malakh, Warnecke Gregor, Ismail Issam, Rümke Stefan, Cebotari Serghei, Haverich Axel, Tudorache Igor
Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Thorac Cardiovasc Surg. 2018 Oct;66(7):545-551. doi: 10.1055/s-0038-1627478. Epub 2018 Feb 28.
Minimally invasive mitral valve surgery (MIMVS) is superior to "classical" mitral valve surgery via a sternotomy regarding wound healing and postoperative pain. It is however a more challenging procedure. Patients' preference is leading clearly toward minimally invasive approaches, and surgeons are driven by upcoming new technologies in interventional procedures such as the MitraClip. Especially in re-do cases, the access via right mini-thoracotomy, as previously non-operated situs, is a possible advantage over a re-sternotomy. We therefore retrospectively analyzed our result regarding MIMVS in re-do cases at our institute.
From January 2011 and June 2016, 33 operations were MIMVS re-do procedures. Mean age was 60 years (±16 years), and 51% were male.
Sixty-one percent were elective cases, 29% were urgent cases, and 9% were emergency operations. Operation times, cardiopulmonary bypass (CPB) times, and clamp times were 235 minutes (±51 min), 149 minutes (±42 min), and 62 minutes (±45min), respectively. Mitral valve repair and replacement was performed in 24% ( = 8) and 76% ( = 25), respectively. Overall in-hospital mortality, apoplexy, and re-operation rates (all for bleeding) were 0% ( = 0), 3% ( = 1), and 9% ( = 3). New onset of dialysis was required in two (6%) patients. Two (6%) patients developed superficial wound infection. Overall intensive care unit (ICU) and hospital stay was 3 days (±4 days) and 15 days (±7 days), respectively.
MIMVS for re-do cases can be performed with minimal mortality and morbidity and therefore represents a safe alternative to conventional mitral valve surgery in cardiac re-do operations. However, postoperative morbidity is highly dependent on preoperative patient status.
在伤口愈合和术后疼痛方面，微创二尖瓣手术（MIMVS）优于经胸骨切开术的“传统”二尖瓣手术。然而，这是一个更具挑战性的手术。患者的偏好显然倾向于微创方法，并且外科医生受到诸如MitraClip等介入手术中即将出现的新技术的推动。特别是在再次手术的病例中，通过右胸小切口进入，作为先前未手术的部位，相对于再次胸骨切开术可能具有优势。因此，我们回顾性分析了我院再次手术病例中MIMVS的结果。
2011年1月至2016年6月，33例手术为MIMVS再次手术。平均年龄为60岁（±16岁），51%为男性。
61%为择期病例，29%为紧急病例，9%为急诊手术。手术时间、体外循环（CPB）时间和夹闭时间分别为235分钟（±5分钟）、149分钟（±42分钟）和62分钟（±45分钟）。二尖瓣修复和置换分别占24%（=8）和76%（=25）。总体住院死亡率、中风和再次手术率（均为出血）分别为0%（=0）、3%（=1）和9%（=3）。两名（6%）患者需要开始透析。两名（6%）患者发生浅表伤口感染。总体重症监护病房（ICU）和住院时间分别为3天（±4天）和15天（±7天）。
再次手术病例的MIMVS可以在死亡率和发病率最低的情况下进行，因此在心脏再次手术中是传统二尖瓣手术的安全替代方案。然而，术后发病率高度依赖于术前患者状态。
