Yamazaki Masataka, Yoshitake Akihiro, Takahashi Tatsuo, Ito Tsutomu, Kimura Naritaka, Hirano Akinori, Iida Yasunori, Takanashi Shuichiro, Shimizu Hideyuki
Department of Cardiovascular Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan.
Gen Thorac Cardiovasc Surg. 2018 Dec;66(12):700-706. doi: 10.1007/s11748-018-0987-x. Epub 2018 Aug 16.
Trans-right axillary aortic valve replacement (TAX-AVR) remains uncommon. We developed a special method to pull the heart closer to the right chest wall to make the surgery as easy and safe as aortic valve replacement via median sternotomy. Because the retraction sutures lifting the ascending aorta and aortic root are arranged circularly around the wound, we named this technique "Stonehenge technique".
We examined 47 patients who underwent aortic valve replacement through a small right infra-axillary thoracotomy as the initial surgical therapy. These patients were divided into two groups: the conventional TAX-AVR group that underwent AVR via the conventional small right axillary incision approach (n = 20) and the TAX-AVR with SH group that underwent AVR with the Stonehenge technique (n = 27).
The aortic cross-clamp and the extracorporeal circulation time were significantly shorter in the TAX-AVR with SH group than in the conventional TAX-AVR group (conventional TAX-AVR group: 125.5 ± 47.9; TAX-AVR with SH group: 96.0 ± 14.0, p = 0.004, and conventional TAX-AVR group: 163.8 ± 55.9; TAX-AVR with SH group: 140.0 ± 16.8, p = 0.04).
The outcomes of this technique depend on the site of the retraction sutures in the opened pericardium, direction of pull, amount of force applied, and precautions taken. If performed correctly, the ascending aorta and the root can be pulled from the wound to within the surgeon's fingers' reach, thereby reducing aortic cross-clamp and extracorporeal circulation times in group of minimally invasive aortic valve replacement via right infra-axillary thoracotomy.
经右腋下主动脉瓣置换术（TAX-AVR）仍不常见。我们开发了一种特殊方法，将心脏拉近右胸壁，以使手术像经正中胸骨切开术进行主动脉瓣置换一样简便和安全。由于提升升主动脉和主动脉根部的牵引缝线围绕伤口呈环形排列，我们将此技术命名为“巨石阵技术”。
我们检查了47例作为初始手术治疗通过右腋下小切口进行主动脉瓣置换的患者。这些患者分为两组：通过传统右腋下小切口入路进行主动脉瓣置换的传统TAX-AVR组（n = 20）和采用巨石阵技术进行主动脉瓣置换的TAX-AVR伴SH组（n = 27）。
TAX-AVR伴SH组的主动脉阻断和体外循环时间明显短于传统TAX-AVR组（传统TAX-AVR组：125.5±47.9；TAX-AVR伴SH组：96.0±14.0，p = 0.004；传统TAX-AVR组：163.8±55.9；TAX-AVR伴SH组：140.0±16.8，p = 0.04）。
该技术的效果取决于心包打开时牵引缝线的位置、牵引方向、施加的力量大小以及采取的预防措施。如果操作正确，升主动脉和根部可从伤口处被拉到外科医生手指可及范围内，从而减少经右腋下小切口进行微创主动脉瓣置换组的主动脉阻断和体外循环时间。
