Cui Huimin, Zhang Lin, Wei Shixiong, Li Lianggang, Ren Tong, Wang Yao, Jiang Shengli
Department of Cardiovascular Surgery, Chinese PLA General Hospital, Beijing, China.
Cardiovasc Diagn Ther. 2020 Aug;10(4):841-848. doi: 10.21037/cdt-20-440.
We reported our experience of 100 consecutive cases of thoracoscopic mitral valvuloplasty in the early period.
Between September 2017 and December 2019, 100 consecutive cases (aged 49.2±14.7 years; 56% male) of thoracoscopic mitral valvuloplasty had been completed in our institution. The safety and feasibility of this technique was evaluated by its early clinical outcomes.
Mitral valve (MV) repair was performed by means of Carpentier techniques, including leaflet folding in 5 cases, cleft suture in 10, commissuroplasty in 15 including 2 commissurotomy, edge to edge in 1, artificial chordae implantation in 76 cases with an average of 2.5±1.6 (1 to 4) pairs, and prosthetic annuloplasty in all cases. Intraoperative transoesophageal echocardiography (TEE) revealed no mitral regurgitation (MR) in 95 cases and a mild in 2 cases with all coaptation length more than 5 mm. The rest 3 cases with moderate or more MR were successfully reconstructed during a second pump-run. The average cardiopulmonary bypass (CPB) time was 164.4±51.0 min and aortic clamping time was 119.7±39.1 min, and the latest 10 cases were 140.2±45.3 and 96.3±25.4 min, respectively (P<0.05). There was only one operative death from avulsion of left atrial suture after operation and 2 intraoperative re-exploration through a conversion to sternotomy for bleeding. Severe MR was observed in 2 patients 3 months after operation, and MV replacement (MVR) was performed through median sternotomy.
Totally thoracoscopic mitral valvuloplasty was technically feasible, safe, effective, and reproducible in clinical practice after crossing the learning curve.
我们报告了早期连续100例胸腔镜二尖瓣成形术的经验。
2017年9月至2019年12月，我们机构完成了连续100例胸腔镜二尖瓣成形术（年龄49.2±14.7岁；56%为男性）。通过早期临床结果评估该技术的安全性和可行性。
采用Carpentier技术进行二尖瓣修复，包括5例瓣叶折叠、10例裂伤缝合、15例瓣叶交界成形术（包括2例交界切开术）、1例缘对缘修复、76例人工腱索植入（平均2.5±1.6（1至4）对），所有病例均行人工瓣环成形术。术中经食管超声心动图（TEE）显示95例无二尖瓣反流（MR），2例轻度反流，所有瓣叶对合长度均超过5mm。其余3例中度或以上MR患者在第二次体外循环期间成功重建。平均体外循环（CPB）时间为164.4±51.0分钟，主动脉阻断时间为119.7±39.1分钟，最近10例分别为140.2±45.3和96.3±25.4分钟（P<0.05）。术后仅1例因左心房缝线撕脱死亡，2例因出血术中转为胸骨正中切开再次探查。术后3个月2例患者出现严重MR，通过胸骨正中切开进行二尖瓣置换（MVR）。
在跨越学习曲线后，全胸腔镜二尖瓣成形术在临床实践中技术上可行、安全、有效且可重复。
