Sawadogo Adama, Nguyen Hoang Nam, D'Ostrevy Nicolas, Camilleri Lionel, Azarnoush Kasra
Department of Cardiovascular Surgery, University Hospital of Clermont-Ferrand 63003 Clermont-Ferrand, France.
Department of Surgery, University Hospital of Tengandogo, Burkina Faso.
J Cardiovasc Thorac Res. 2020;12(2):84-89. doi: 10.34172/jcvtr.2020.15. Epub 2020 May 22.
Minimally invasive approach in cardiac surgery has become an established and common technique in many cardiac surgery centres throughout the world. We report how we safely introduced minimally invasive approach in cardiac surgery in our department and we aim to demonstrate that this approach is feasible in any medium-size cardiac surgical centre. it consisted of retrospective and descriptive study on 60 patients who underwent minimally invasive mitral valve (45) or aortic valve surgery (15) from January 2017 to Februry 2018. The approach was 3 to 6-cm right thoracotomy through the 4th and 5th intercostal space. The Cor-KnotTM system was used to tie the knots of the prosthesis in case of mitral valve replacement and aortic valve replacement and the ring if mitral valve repair. There was no conversion of thoracotomy to sternotomy. The average duration in ICU was 4.3± 2.3 days and 3.3 ± 1.5 respectively for mitral and aortic valve surgery. Four mitral patients and 1 aortic patient were reoperated for bleeding. No in-hospital death was observed. The postoperative discharge echocardiogram was normal in 95.6% of the mitral valve patients the trans-aortic mean gradient for the aortic valve patients was 16.3 ± 6 mm Hg. The thirty-day mortality was zero. In the majority of the patients, the scar of the thoracotomy were almost unseen. It is possible to safely implement this new approach in any mid-size cardiac centers. The use of modern technology such as 3D video and Cor Knot allows achievement of excellent short term outcomes.
心脏手术中的微创方法在全球许多心脏外科中心已成为一种成熟且常用的技术。我们报告了我们科室如何安全地引入心脏手术的微创方法，旨在证明这种方法在任何中等规模的心脏外科中心都是可行的。本研究包括对2017年1月至2018年2月期间接受微创二尖瓣手术（45例）或主动脉瓣手术（15例）的60例患者进行回顾性和描述性研究。手术入路为经第4和第5肋间间隙进行3至6厘米的右胸壁切开术。在二尖瓣置换和主动脉瓣置换时使用Cor-KnotTM系统系紧人工瓣膜的结，二尖瓣修复时系紧瓣环。没有开胸手术转为胸骨切开术的情况。二尖瓣和主动脉瓣手术在重症监护病房的平均住院时间分别为4.3±2.3天和3.3±1.5天。4例二尖瓣手术患者和1例主动脉瓣手术患者因出血接受了再次手术。未观察到院内死亡。二尖瓣手术患者术后出院时超声心动图正常的比例为95.6%，主动脉瓣手术患者的跨主动脉平均压差为16.3±6毫米汞柱。30天死亡率为零。在大多数患者中，胸壁切开术的疤痕几乎看不见。在任何中等规模的心脏中心安全实施这种新方法是可行的。使用3D视频和Cor Knot等现代技术可实现优异的短期效果。
