肺动脉高压患者的二尖瓣手术：微创手术安全吗？

Mitral Valve Surgery in Pulmonary Hypertension Patients: Is Minimally Invasive Surgery Safe?

机构信息

Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.

出版信息

Ann Thorac Surg. 2021 Jun;111(6):2012-2019. doi: 10.1016/j.athoracsur.2020.06.147. Epub 2020 Sep 28.

DOI:10.1016/j.athoracsur.2020.06.147

PMID:32991840

Abstract

BACKGROUND

Compared with conventional full sternotomy (FS) approaches, minimally invasive mitral valve surgery (MIMVS) offers improved cosmesis, decreased pain and bleeding, and faster recovery without compromising repair or survival rates. However, little is known about outcomes in patients with pulmonary hypertension (PH), an independent risk factor for morbidity and mortality.

METHODS

Retrospective review was performed between 2002 and 2019 for all adult patients undergoing isolated mitral valve surgery. Patients with PH (mean pulmonary artery pressure ≥25 mm Hg) were stratified by FS or MIMVS, and nearest-neighbor propensity score matching was performed to adjust for differences in baseline characteristics.

RESULTS

Overall, 591 operations (317 MIMVS, 274 FS) met inclusion criteria during the study period. Nearest-neighbor propensity matching generated 112 well-matched pairs. Cardiopulmonary bypass (137 vs 89.5 minutes, P < .001), cross-clamp (102 vs 63 minutes, P < .001), and total operative times (241 vs 178.5 minutes, P < .001) were longer for the MIMVS group. Postoperatively, MIMVS was associated with shorter initial ventilator times (6 vs 9.6 hours, P < .001) and hospital lengths of stay (7 vs 8 days, P = .049), as well as blood product usage rates (26.8% vs 41.1%, P = .03). Survival at 30 days (0.0% vs 2.7%, P = .12) and 10 years (log-rank, P = .661) were similar between groups.

CONCLUSIONS

MIMVS is safe in patients with PH and provides traditional benefits of minimally invasive surgery, including shorter initial ventilator times and hospital length of stay, without compromising on long-term survival.

摘要

背景

与传统的完全胸骨切开术（FS）相比，微创二尖瓣手术（MIMVS）具有改善美容效果、减少疼痛和出血以及更快恢复的优势，而不会影响修复或生存率。然而，对于肺动脉高压（PH）患者的结局，人们知之甚少，PH 是发病率和死亡率的独立危险因素。

方法

回顾性分析了 2002 年至 2019 年期间所有接受单纯二尖瓣手术的成年患者。根据 FS 或 MIMVS 将 PH 患者（平均肺动脉压≥25mmHg）进行分层，并进行最近邻倾向评分匹配以调整基线特征的差异。

结果

在研究期间，共有 591 例手术（317 例 MIMVS，274 例 FS）符合纳入标准。最近邻倾向评分匹配生成了 112 对匹配良好的病例。MIMVS 组体外循环（137 与 89.5 分钟，P<0.001）、主动脉阻断（102 与 63 分钟，P<0.001）和总手术时间（241 与 178.5 分钟，P<0.001）较长。术后，MIMVS 与较短的初始呼吸机时间（6 与 9.6 小时，P<0.001）和住院时间（7 与 8 天，P=0.049）以及血液制品使用率（26.8%与 41.1%，P=0.03）相关。30 天（0.0%与 2.7%，P=0.12）和 10 年（对数秩，P=0.661）的生存率在两组之间相似。