Zhang Hang, Xu Hua-Shan, Wen Bing, Zhao Wen-Zeng, Liu Chao
Department of Cardiovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China.
J Cardiothorac Surg. 2020 Jun 3;15(1):122. doi: 10.1186/s13019-020-01171-6.
To analyze the efficacy of minimally invasive beating heart technique for mitral valve surgery in the cardiac patients with previous sternotomy and giant left ventricle.
Eighty cardiac patients with previous sternotomy and giant left ventricle according to the diagnostic criteria that left ventricular end diastolic diameter (LVEDD) was ≥70 mm, who underwent mitral valve surgery at our center from January 2006 to January 2019 were analyzed. We divided all patients into minimally invasive beating heart technique group (n = 30) and conventional median resternotomy arrested heart technique group (n = 50) according to the surgical methods. Preoperative, intraoperative, and postoperative variables were compared between two groups.
Minimally invasive beating heart technique compared to the conventional median resternotomy arrested heart technique for mitral valve surgery in the cardiac patients with previous sternotomy and giant left ventricle had significant differences in operation time(P = 0.002), cardiopulmonary bypass (CPB) time(P < 0.001), intraoperative blood loss(P < 0.001), postoperative transfusion ratio(P = 0.01), postoperative transfusion amount(P < 0.001), postoperative drainage volume(P = 0.001), extubation time(P = 0.04), intensive care unit (ICU) stay time(P = 0.04) and postoperative hospital stay time(P < 0.001), but no significant differences in re-exploration for bleeding, postoperative 30-day mortality, postoperative complications and 6 months postoperative echocardiographic parameters.
Using the method of minimally invasive beating heart technique for mitral valve surgery in the cardiac patients with previous sternotomy and giant left ventricle is effective and reliable, meanwhile reduce the operation time and CPB time, decrease the transfusion ratio and transfusion amount, shorten postoperative ICU stay and hospital stay time, promote the early extubation so that accelerate the patients' early recovery. All of these show a benefit of minimally invasive beating heart technique compared to conventional median resternotomy arrested heart technique.
分析微创心脏跳动技术在有开胸手术史及巨大左心室的心脏患者二尖瓣手术中的疗效。
分析2006年1月至2019年1月在本中心接受二尖瓣手术的80例有开胸手术史及巨大左心室的心脏患者，根据诊断标准左心室舒张末期内径（LVEDD）≥70mm。根据手术方法将所有患者分为微创心脏跳动技术组（n = 30）和传统正中再次开胸心脏停跳技术组（n = 50）。比较两组术前、术中和术后变量。
对于有开胸手术史及巨大左心室的心脏患者，二尖瓣手术采用微创心脏跳动技术与传统正中再次开胸心脏停跳技术相比，在手术时间（P = 0.002）、体外循环（CPB）时间（P < 0.001）、术中失血（P < 0.001）、术后输血比例（P = 0.01）、术后输血量（P < 0.001）、术后引流量（P = 0.001）、拔管时间（P = 0.04）、重症监护病房（ICU）停留时间（P = 0.04）和术后住院时间（P < 0.001）方面有显著差异，但在出血再次探查、术后30天死亡率、术后并发症和术后6个月超声心动图参数方面无显著差异。
对于有开胸手术史及巨大左心室的心脏患者，采用微创心脏跳动技术进行二尖瓣手术是有效且可靠的，同时可缩短手术时间和CPB时间，降低输血比例和输血量，缩短术后ICU停留时间和住院时间，促进早期拔管，从而加速患者早期康复。所有这些表明与传统正中再次开胸心脏停跳技术相比，微创心脏跳动技术具有优势。
