Kilic Arman, Szeto Wilson Y, Atluri Pavan, Acker Michael A, Clark Hargrove W
Division of Cardiac Surgery, University of Pittsburgh, PA, USA.
Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, USA.
Innovations (Phila). 2019 Oct;14(5):412-418. doi: 10.1177/1556984519864939. Epub 2019 Jul 24.
The aim of this study was to evaluate whether the addition of concomitant tricuspid valve surgery (TVS) negatively impacted operative outcomes of minimally invasive mitral valve surgery (MIMVS).
Patients undergoing MIMVS via a port-access right minithoracotomy between 2002 and 2014 at a single institution were reviewed. Patients were primarily stratified by those undergoing isolated MIMVS versus MIMVS+TVS. Propensity-matched cohorts were generated. Operative outcomes were compared between the propensity-matched cohorts and included operative mortality, complications, and length of hospital stay.
A total of 1,158 patients underwent MIMVS via port-access right minithoracotomy. The majority of cases were elective (93%; = 1,071) and 148 (13%) underwent concomitant MIMVS + TVS. Patients undergoing MIMVS + TVS were at higher risk at baseline. After propensity-matching, there were 119 isolated MIMVS and 119 MIMVS + TVS patients that were well matched with respect to all baseline variables. Cardiopulmonary bypass (148 ± 54 minutes versus 175 ± 54 minutes, < 0.001) and aortic occlusion times (105 ± 36 minutes versus 128 ± 40 minutes, < 0.001) were longer in the MIMVS + TVS group. Operative mortality was comparable (3% isolated MIMVS versus 4% for MIMVS + TVS; = 0.73). Permanent pacemakers were required less frequently in the isolated MIMVS group (1% versus 6%; = 0.03). All other complication rates were similar. Median length of hospital stay (7 versus 8 days; = 0.13) and discharge-to-home rates (89% versus 94%; = 0.15) were comparable.
Despite longer operative times, minimally invasive TVS performed concomitantly with MIMVS has similar operative outcomes with the exception of a higher pacemaker rate when compared with isolated MIMVS.
本研究旨在评估同期进行三尖瓣手术（TVS）是否会对微创二尖瓣手术（MIMVS）的手术结果产生负面影响。
回顾了2002年至2014年在单一机构通过右胸壁小切口经端口入路进行MIMVS的患者。患者主要分为单纯MIMVS组和MIMVS + TVS组。生成倾向匹配队列。比较倾向匹配队列之间的手术结果，包括手术死亡率、并发症和住院时间。
共有1158例患者通过右胸壁小切口经端口入路进行了MIMVS。大多数病例为择期手术（93%；n = 1071），148例（13%）接受了同期MIMVS + TVS。接受MIMVS + TVS的患者在基线时风险更高。倾向匹配后，有119例单纯MIMVS患者和119例MIMVS + TVS患者在所有基线变量方面匹配良好。MIMVS + TVS组的体外循环时间（148±54分钟对175±54分钟，P<0.001）和主动脉阻断时间（105±36分钟对128±40分钟，P<0.001）更长。手术死亡率相当（单纯MIMVS组为3%，MIMVS + TVS组为4%；P = 0.73）。单纯MIMVS组永久性起搏器的使用频率较低（1%对6%；P = 0.03）。所有其他并发症发生率相似。中位住院时间（7天对8天；P = 0.13）和出院回家率（89%对94%；P = 0.15）相当。
尽管手术时间更长，但与单纯MIMVS相比，同期进行的微创TVS除了起搏器使用率较高外，手术结果相似。
