Vo Anh Tuan, Le Khoi Minh, Nguyen Trang Thu, Vu Thien Tam, Pham Chuong Viet Tran, Ngo Huy Quoc Tuan, Le Tri Quang, Nguyen Dinh Hoang
Department of Cardiovascular Surgery, University Medical Center, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam.
Heart Surg Forum. 2019 Sep 24;22(5):E390-E395. doi: 10.1532/hsf.2529.
The development of minimally invasive mitral valve surgery has created the motivation for using this approach in young patients with chronic rheumatic valve disease. We report our recent experience with patients undergoing minimally mitral valve surgery in this group of patients.
Between July 2014 and June 2018, 142 patients with rheumatic mitral valve dysfunction underwent minimally invasive surgery through a right thoracotomy approach at the University Medical Center of Ho Chi Minh City in Vietnam. Diagnosis was confirmed with transthoracic and transesophageal echocardiography (TTE and TEE). We analyzed the in-hospital and midterm follow-up outcomes of this group.
The mean age was 42.6 ± 9.6 years. Sixty patients (42.3%) were male. Sixty-three patients were diagnosed with functional severe tricuspid regurgitation, 29 patients were identified with moderate tricuspid regurgitation, and tricuspid annulus was more than 21 mm/m²). Mitral valve repair was performed in 16 patients (11.3%), and 126 patients underwent mitral valve replacement. Mitral valve repair techniques included annuloplasty, leaflet peeling, and commissurotomy. Thirty-day mortality was 0.7%. Two patients had to be converted to conventional sternotomy, due to left atrial appendage laceration and mitral annular rupture. The overall survival rate was 98.6%. Freedom from reoperation was 97.1%.
In patients with rheumatic valve disease, minimally invasive mitral surgery safely and effectively can be performed with few perioperative complications and good midterm results.
微创二尖瓣手术的发展促使人们将这种方法应用于患有慢性风湿性瓣膜病的年轻患者。我们报告了近期在这组患者中进行微创二尖瓣手术的经验。
2014年7月至2018年6月期间，越南胡志明市大学医学中心的142例风湿性二尖瓣功能障碍患者通过右胸壁切开术进行了微创手术。经胸和经食管超声心动图（TTE和TEE）确诊。我们分析了该组患者的住院及中期随访结果。
平均年龄为42.6±9.6岁。60例（42.3%）为男性。63例患者被诊断为功能性严重三尖瓣反流，29例患者被确定为中度三尖瓣反流，三尖瓣环大于21mm/m²。16例（11.3%）患者进行了二尖瓣修复，126例患者进行了二尖瓣置换。二尖瓣修复技术包括瓣环成形术、瓣叶剥离术和交界切开术。30天死亡率为0.7%。由于左心耳撕裂和二尖瓣环破裂，2例患者不得不转为传统胸骨切开术。总生存率为98.6%。再次手术的自由度为97.1%。
对于风湿性瓣膜病患者，微创二尖瓣手术可安全有效地进行，围手术期并发症少，中期效果良好。
