Gerber Witold, Sanetra Krzysztof, Kuczera Małgorzata, Białek Krzysztof, Zembala Marian, Cisowski Marek
1 Department of Cardiac Surgery, American Heart of Poland, Bielsko-Biala, Poland.
Center for Cardiovascular Research and Development, American Heart of Poland, Bielsko-Biala, Poland.
Kardiochir Torakochirurgia Pol. 2019 Mar;16(1):27-31. doi: 10.5114/kitp.2019.83942. Epub 2019 Apr 4.
Minimally invasive mitral repair is less traumatic and more acceptable for the patient than traditional surgery. However, it is a challenging procedure that requires effort from all the personnel involved.
To investigate the results of the minimally invasive mitral valve repair learning curve at the institution.
The indication for the surgery was severe mitral regurgitation. Patients with other valvular insufficiency, body mass index (BMI) > 30 kg/m, ejection fraction (EF) < 45%, aortic dilatation, reoperation, pleural adhesions, coronary artery disease requiring invasive treatment, and pregnant women were disqualified. The patients were assigned to one of three groups regarding their surgery date - group 1 (2012-2013), group 2 (2014-2015) and group 3 (2016-2017). The primary endpoints were death, myocardial infarction, stroke, an reoperation for mitral dysfunction. The investigation was performed to determine preoperative parameters (EuroSCORE, age, sex, BMI, arrhythmias, EF), intraoperative parameters (procedure, cross-clamp, extracorporeal circulation), and postoperative parameters (chest revision, transfusion, drainage, ventilation time, pleurocentesis, hospitalization time).
There were 173 patients in total. One patient from group 1 (0.6% overall) died. No myocardial infarction or stroke was observed in any of the three groups. Chest revision count (5 vs. 1 vs. 1; = 0.0004), total drainage (797.20 vs. 517.92 vs. 449.69; = 0.0018) and hospitalization time (7.89 vs. 7.18 vs. 6.73; = 0.0005) were significantly different among the groups. The ventilation time, transfusion number and pleurocentesis count did not differ significantly.
The procedure is safe and ensures optimal perioperative results. The number of complications is low and acceptable.
与传统手术相比，微创二尖瓣修复术对患者的创伤更小，更容易被患者接受。然而，这是一个具有挑战性的手术，需要所有参与人员的共同努力。
研究该机构微创二尖瓣修复术学习曲线的结果。
手术适应症为严重二尖瓣反流。患有其他瓣膜功能不全、体重指数（BMI）>30kg/m、射血分数（EF）<45%、主动脉扩张、再次手术、胸膜粘连、需要侵入性治疗的冠状动脉疾病以及孕妇被排除在外。根据手术日期将患者分为三组——第1组（2012 - 2013年）、第2组（2014 - 2015年）和第3组（2016 - 2017年）。主要终点为死亡、心肌梗死、中风以及因二尖瓣功能障碍再次手术。进行该调查以确定术前参数（欧洲心脏手术风险评估系统（EuroSCORE）、年龄、性别、BMI、心律失常、EF）、术中参数（手术过程、交叉夹闭、体外循环）以及术后参数（胸部修复、输血、引流、通气时间、胸腔穿刺、住院时间）。
总共有173名患者。第1组有1名患者死亡（总体死亡率为0.6%）。三组中均未观察到心肌梗死或中风。各组之间胸部修复次数（5比1比1；P = 0.0004）、总引流量（797.20比517.92比449.69；P = 0.0018）和住院时间（7.89比7.18比6.73；P = 0.0005）存在显著差异。通气时间、输血量和胸腔穿刺次数无显著差异。
该手术是安全的，并能确保最佳的围手术期效果。并发症数量少且在可接受范围内。
