Oezpeker Cenk, Barbieri Fabian, Hoefer Daniel, Schneider Bastian, Bonaros Nikolaos, Grimm Michael, Mueller Ludwig
Department of Cardiac Surgery, Landeskrankenhaus Innsbruck Universitatskliniken, Innsbruck, Austria.
Thorac Cardiovasc Surg. 2019 Oct;67(7):524-530. doi: 10.1055/s-0038-1667144. Epub 2018 Sep 4.
Minithoracotomy (MT) has gained broad acceptance for mitral valve surgery (MVS) in the last decade. In the presence of defined limitations of MT, however, full sternotomy (FS) is still widely preferred. We assume that the less investigated partial upper sternotomy (PS) will permit the gap between MT and FS in MVS to be closed. The purpose of this study is to investigate a valid less invasive alternative to MT for isolated MVS or multivalve surgery.
This retrospective analysis includes data on 1,639 patients, who underwent either isolated or combined primary MVS at our department from May 2011 to August 2017. Out of these, 663 patients were operated via MT access. One-hundred three patients had been judged as not suitable for MT but feasible for PS approach in which 53.4% ( = 55) had isolated MVS and 46.6% patients ( = 48) underwent multivalve surgery. Concomitant myocardial revascularization was performed in 2.9% of the study patients ( = 3).
Operative, 90-day, and 1-year mortality in the PS-cohort was 0, 1.0% ( = 1), and 3.3% ( = 3), respectively. During a median follow-up time of 1,115 days (interquartile range 398-1806), all-cause mortality was 5.8% ( = 6). Operative times for cardiopulmonary-bypass and cross-clamping were 167 minutes (140-198) and 107 minutes (93-132), respectively. Median length of stay at the intensive care unit and hospital was 1 (1-2) and 7 days (7-10), respectively.
The presented results demonstrate that there is a cohort of patients, who are not candidates for MT in MVS but may be operated successfully by an alternative less invasive approach.
在过去十年中，微创开胸术（MT）在二尖瓣手术（MVS）中已获得广泛认可。然而，鉴于MT存在明确的局限性，全胸骨切开术（FS）仍然被广泛采用。我们认为，较少被研究的部分上胸骨切开术（PS）将弥合MT与MVS中FS之间的差距。本研究的目的是研究一种有效的、侵入性较小的替代MT的方法，用于单纯MVS或多瓣膜手术。
这项回顾性分析纳入了2011年5月至2017年8月在我科接受单纯或联合原发性MVS手术的1639例患者的数据。其中，663例患者通过MT入路进行手术。103例患者被判定不适合MT但适合PS入路，其中53.4%（n = 55）为单纯MVS，46.6%（n = 48）患者接受了多瓣膜手术。2.9%（n = 3）的研究患者同时进行了心肌血运重建。
PS组的手术死亡率、90天死亡率和1年死亡率分别为0、1.0%（n = 1）和3.3%（n = 3）。在中位随访时间1115天（四分位间距398 - 1806天）内，全因死亡率为5.8%（n = 6）。体外循环和主动脉阻断的手术时间分别为167分钟（140 - 198分钟）和107分钟（93 - 132分钟）。重症监护病房和医院的中位住院时间分别为1天（1 - 2天）和7天（7 - 10天）。
所呈现的结果表明，在MVS中，有一部分患者不适合MT，但可以通过另一种侵入性较小的方法成功进行手术。
