Chernov Igor, Enginoev Soslan, Koz'min Dmitry, Magomedov Gasan, Tarasov Dmitry, Sá Michel Pompeu B O, Weymann Alexander, Zhigalov Konstantin
Federal Center for Cardiovascular Surgery Department of Cardiac Surgery Astrakhan Russia Department of Cardiac Surgery, Federal Center for Cardiovascular Surgery, Astrakhan, Russia.
Astrakhan State Medical University Department of Cardiovascular Surgery Astrakhan Russia Department of Cardiovascular Surgery, Astrakhan State Medical University, Astrakhan, Russia.
Braz J Cardiovasc Surg. 2020 Apr 1;35(2):185-190. doi: 10.21470/1678-9741-2019-0430.
To compare the in-hospital outcomes of a right-sided anterolateral minithoracotomy with those of median sternotomy in patients who received a mitral valve replacement (MVR) because of rheumatic mitral valve stenosis (RMS).
This is a retrospective analysis of 128 patients (34% male) with RMS between 2011 and 2015. The median age was 53 years (45; 56). The mean ejection fraction was 58.4±6.3%. All the subjects were divided into two groups - Group 1 contained 78 patients who underwent MVR via minithoracotomy (MT-MVR), while Group 2 contained 50 patients who underwent MVR via median sternotomy (S-MVR).
In the MT-MVR group, a mechanical prosthesis was implanted in 72% of cases, while it was implanted in 90% of cases in the S-MVR group (P=0.01). The duration of myocardial ischemia was similar (MT-MVR, 77±24 min; S-MVR, 70±18 min) (P=0.09). However, the cardiopulmonary bypass time was lower in the S-MVR group than in the MT-MVR group (99±24 min and 119±34 min, respectively) (P≤0.001). There was no difference in the duration of mechanical ventilation, intensive care unit stay, and hospitalization period. Postoperative blood loss was lower in the MT-MVR group (P≤0.001) than in the S-MVR group. There are no statistically significant differences in postoperative complications (superficial wound infection, stroke, delirium, pericardial tamponade, pleural puncture, acute kidney insufficiency, and implantation of pacemaker). The overall in-hospital mortality was 3.9% (P=0.6).
The minimally invasive approach for RMS is feasible and has an excellent cosmetic effect without increasing the risk of surgical complications.
比较因风湿性二尖瓣狭窄（RMS）接受二尖瓣置换术（MVR）的患者，经右侧前外侧小切口开胸手术与正中胸骨切开术的院内结局。
这是一项对2011年至2015年间128例RMS患者（男性占34%）的回顾性分析。中位年龄为53岁（45；56）。平均射血分数为58.4±6.3%。所有受试者分为两组——第1组包含78例行小切口开胸二尖瓣置换术（MT-MVR）的患者，而第2组包含50例行正中胸骨切开二尖瓣置换术（S-MVR）的患者。
在MT-MVR组中，72%的病例植入了机械瓣膜，而S-MVR组中这一比例为90%（P = 0.01）。心肌缺血持续时间相似（MT-MVR组为77±24分钟；S-MVR组为70±18分钟）（P = 0.09）。然而，S-MVR组的体外循环时间低于MT-MVR组（分别为99±24分钟和119±34分钟）（P≤0.001）。机械通气时间、重症监护病房停留时间和住院时间无差异。MT-MVR组术后失血量低于S-MVR组（P≤0.001）。术后并发症（浅表伤口感染、中风、谵妄、心包填塞、胸腔穿刺、急性肾功能不全和起搏器植入）无统计学显著差异。总体院内死亡率为3.9%（P = 0.6）。
RMS的微创方法是可行的，具有良好的美容效果，且不增加手术并发症风险。
