GVM Care & Research, Department of Cardiovascular Surgery, Anthea Hospital, Bari, Italy.
GVM Care & Research, Department of Cardiovascular Surgery, Anthea Hospital, Bari, Italy.
Ann Thorac Surg. 2018 Sep;106(3):728-734. doi: 10.1016/j.athoracsur.2018.04.010. Epub 2018 May 8.
Complex mitral valve disease can require surgical repair techniques that are challenging in a minimally invasive context and may expose patients to prolonged cardiopulmonary bypass and cross-clamp times. This study reviewed a simplified stepwise operative approach for the treatment of complex bileaflet mitral disease, early outcomes, and midterm follow-up.
A total of 140 consecutive patients with bileaflet disease underwent video-assisted minimally invasive right mitral valve repair at a surgical center (Anthea Hospital, Bari, Italy) between 2008 and 2016. Patients were treated with a technique consisting of relocating the head of P2 to the base of P1 with resection and sliding. If P1 was prolapsed, a commissural plication was performed. Neochordae were applied at the level of the anterior segments in cases of true prolapse or flail. An isolated complete ring was used in cases of bileaflet billowing. This study retrospectively reviewed early and midterm outcomes including follow-up echocardiographic data.
There was no 30-day mortality, and successful mitral valve repair with no or trace mitral regurgitation was achieved in all but 1 patient. One patient at the beginning of the series required conversion to sternotomy, and 2 patients required immediate reoperation for systolic anterior movement. No deaths were reported at a median follow-up of 32 months, and the rate of freedom from mitral regurgitation (≥2+) was 94.7%. The type of repair did not influence the outcome.
Complex mitral disease in its different forms can be successfully addressed with excellent early and midterm results by using a simplified stepwise minimally invasive mitral valve repair technique.
复杂的二尖瓣疾病可能需要在微创手术中进行具有挑战性的修复技术，这可能会使患者面临更长的心肺转流和体外循环时间。本研究回顾了一种简化的分步手术方法，用于治疗复杂的双瓣叶二尖瓣疾病、早期结果和中期随访。
2008 年至 2016 年期间，一家外科中心（意大利巴里的 Anthea 医院）共对 140 例连续的双瓣叶疾病患者进行了视频辅助微创右二尖瓣修复。患者采用一种技术进行治疗，该技术包括将 P2 的头部重新定位到 P1 的基部，同时进行切除和滑动。如果 P1 脱垂，则进行连合襻折叠。如果存在真性脱垂或连枷，在前瓣叶水平应用人工腱索。对于双瓣叶飘动，使用单独的完整环。本研究回顾性分析了早期和中期结果，包括随访超声心动图数据。
无 30 天死亡率，除 1 例患者外，所有患者均成功修复二尖瓣，且无或微量二尖瓣反流。该系列开始时的 1 例患者需要转为胸骨切开术，2 例患者需要立即进行再次手术以治疗收缩期前向运动。中位随访 32 个月时无死亡病例，二尖瓣反流（≥2+）无复发率为 94.7%。修复类型不影响结果。
通过使用简化的分步微创手术二尖瓣修复技术，可以成功治疗不同形式的复杂二尖瓣疾病，且早期和中期结果良好。
