Department of Cardiothoracic Surgery, MaxCure Hospital, Hitech City, Madhapur, Hyderabad, India.
Department of Cardiothoracic Surgery, MaxCure Hospital, Hitech City, Madhapur, Hyderabad, India.
Ann Thorac Surg. 2020 Feb;109(2):512-516. doi: 10.1016/j.athoracsur.2019.05.075. Epub 2019 Jul 20.
With increasing patient interest in minimally invasive procedures, it is more important than ever for surgeons to be current on the most common minimally invasive techniques in cardiac surgery. As minimally invasive cardiac surgery has evolved, the strategies and approaches to cardiopulmonary bypass access have evolved. Peripheral cannulation is convenient but carries a risk of retrograde dissection, embolization, stroke, and ipsilateral limb ischemia, whereas central aortic cannulation has the advantage of antegrade flow.
We report our experience with direct arterial and venous cannulation through a thoracotomy approach without compromising the results. From January 2017 to December 2018, 140 consecutive patients were studied. Mean age was 26 ± 18 years (range, 11 months to 83 years), with 46 patients (32.8%) younger than 12 years and 12 patients weighing less than 10 kg. Spectrum of procedures include atrial septal defect closure (53%), mitral valve repair (14%), ventricular septal defect closure (9%), aortic valve replacement (10%), mitral valve replacement (6%), repair of partial anomalous pulmonary venous drainage (9%), myxoma excision (1%), and ventricular septal defect closure with pulmonary valvotomy (1%).
None of the patients was converted from a minimally invasive to standard median sternotomy. One patient with ventricular septal defect died due to pulmonary hypertensive crises. No patient required reexploration for bleeding, and none had stroke or renal failure. There were no myocardial infarctions or aortic dissections.
In our experience this approach is a reliable platform for a variety of minimally invasive cardiac surgical procedures and has resulted in low complication rates. The technique can be applied safely to both pediatric and adult populations. Also, it is very cost-effective because regular instruments and cannulas are used.
随着患者对微创手术兴趣的增加，外科医生了解心脏手术中最常见的微创技术比以往任何时候都更为重要。随着微创心脏手术的发展，心肺转流的策略和方法也在不断发展。外周插管方便，但有逆行夹层、栓塞、中风和同侧肢体缺血的风险，而中心主动脉插管具有顺行血流的优势。
我们报告了通过开胸手术进行直接动脉和静脉插管的经验，而不会影响结果。从 2017 年 1 月至 2018 年 12 月，对 140 例连续患者进行了研究。平均年龄为 26±18 岁（范围为 11 个月至 83 岁），其中 46 例（32.8%）年龄小于 12 岁，12 例体重小于 10kg。手术包括房间隔缺损修补术（53%）、二尖瓣修复术（14%）、室间隔缺损修补术（9%）、主动脉瓣置换术（10%）、二尖瓣置换术（6%）、部分肺静脉异常引流修复术（9%）、黏液瘤切除术（1%）和室间隔缺损修补伴肺动脉瓣切开术（1%）。
无患者由微创转为标准正中胸骨切开术。1 例室间隔缺损患者死于肺动脉高压危象。无患者因出血需要再次探查，无中风或肾衰竭。无心肌梗死或主动脉夹层。
根据我们的经验，这种方法是一种可靠的微创心脏外科手术平台，并且导致并发症发生率低。该技术可安全应用于儿科和成人人群。此外，由于使用常规器械和插管，该技术非常具有成本效益。
