Zia Kashif, Mangi Ali R, Bughio Hafeezullah, Tariq Khuzaima, Chaudry Pervaiz A, Karim Musa
Cardiac Surgery, National Institute of Cardiovascular Diseases, Karachi, PAK.
Cardiac Surgery, National Institute of Cardiovascular Disease, Karachi, PAK.
Cureus. 2019 Sep 20;11(9):e5707. doi: 10.7759/cureus.5707.
Introduction Minimally invasive double valve replacement (DVR) surgery through a small transverse anterior thoracotomy is an alternate technique to sternotomy for concomitant aortic and mitral valve (AVR, MVR) surgery. The aim of this study was to evaluate the in-hospital and early outcomes of direct vision minimal invasive double valve surgery (DVMI-DVR) at a tertiary care cardiac center of a developing country. Methods This study was conducted at the National Institute of Cardiovascular Diseases Karachi, Pakistan from January 2018 to September 2018. Nineteen consecutive patients undergoing DVMI-DVR for aortic and mitral disease without any prior cardiac surgery were included in this study. For all procedures, access was obtained through small transverse anterior thoracotomy incision with wedge resection (Chaudhry's Wedge) of sternum opposite to the third and fourth costosternal joints. Patients were observed during their hospital stay and the following variables were observed the length of hospital stay (LOHS), ventilator support, intensive care unit (ICU) stay, pain score, and mortality. The pain score was assessed using the visual analog scale (VAS). Results The male/female ratio was 11:8 with a mean age of 35 ± 12 years with mean EuroSCORE of 6.6 ± 3.5%. The mean total bypass time was 129.8 ± 23.83 min (range: 98-181 minutes). The mean mechanical ventilation time was 3.16 ± 1.12 hours (range: 2-6 hours). The mean intensive care unit (ICU) stay was 41.84 ± 8.36 hours. The mean post-operative LOHS was 5.63 ± 1.12 days (range: 4-8 days). We had zero frequency of wound infection and surgical mortality. The mean pain score was 4.32 (on a predefined pain scale of one to nine with a high value indicating severe pain). Conclusion Minimally invasive DVR surgery is a safe and reproducible technique with comparable outcomes such as postoperative pain score (4.32 ± 2.05), ventilation time (3.16 ± 1.12 hours), ICU stay (41.84 ± 8.36 hours), and hospital stay (5.63 ± 1.12 days). In terms of mortality, operative times, ICU stay, and hospital stay, the minimally invasive DVR is at least comparable to those achieved with median sternotomy. Further prospective randomized studies are needed to validate our findings.
引言 通过小横断前胸切口进行的微创双瓣膜置换术（DVR）是用于同期主动脉瓣和二尖瓣手术（AVR、MVR）的胸骨切开术的替代技术。本研究的目的是评估在一个发展中国家的三级心脏护理中心进行直视微创双瓣膜手术（DVMI-DVR）的院内及早期结果。
方法 本研究于2018年1月至2018年9月在巴基斯坦卡拉奇国家心血管疾病研究所进行。本研究纳入了19例连续接受DVMI-DVR治疗主动脉和二尖瓣疾病且此前未接受过任何心脏手术的患者。对于所有手术，均通过小横断前胸切口并在第三和第四肋软骨关节相对处进行胸骨楔形切除术（乔德里楔形切除术）来建立手术入路。在患者住院期间进行观察，并观察以下变量：住院时间（LOHS）、呼吸机支持、重症监护病房（ICU）停留时间、疼痛评分和死亡率。使用视觉模拟量表（VAS）评估疼痛评分。
结果 男女比例为11:8，平均年龄为35±12岁，平均欧洲心脏手术风险评估系统（EuroSCORE）为6.6±3.5%。平均总体外循环时间为129.8±23.83分钟（范围：98 - 181分钟）。平均机械通气时间为3.16±1.12小时（范围：2 - 6小时）。平均重症监护病房（ICU）停留时间为41.84±8.36小时。术后平均住院时间为5.63±1.12天（范围：4 - 8天）。我们的伤口感染和手术死亡率为零。平均疼痛评分为4.32（在预定义的1至9分疼痛量表上，高分表示剧痛）。
结论 微创DVR手术是一种安全且可重复的技术，其术后疼痛评分（4.32±2.05）、通气时间（3.16±1.12小时）、ICU停留时间（41.84±8.36小时）和住院时间（5.63±1.12天）等结果相当。在死亡率、手术时间、ICU停留时间和住院时间方面，微创DVR至少与正中胸骨切开术相当。需要进一步的前瞻性随机研究来验证我们的发现。
