微创二尖瓣手术：系统安全性分析
Minimally invasive mitral valve surgery: a systematic safety analysis.
作者信息
Ko Kinsing, de Kroon Thom L, Post Marco C, Kelder Johannes C, Schut Karen F, Saouti Nabil, van Putte Bart P
机构信息
Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
出版信息
Open Heart. 2020 Oct;7(2). doi: 10.1136/openhrt-2020-001393.
OBJECTIVE
Minimally invasive surgery is increasingly adopted as an alternative to conventional sternotomy for mitral valve pathology in many centres worldwide. A systematic safety analysis based on a comprehensive list of pre-specified 30-day complications defined by the Mitral Valve Academic Consortium (MVARC) criteria is lacking. The aim of the current study was to systematically analyse the safety of minimally invasive mitral valve surgery in our centre based on the MVARC definitions.
METHODS
All consecutive patients undergoing minimally invasive mitral valve surgery through right mini-thoracotomy in our institution within 10 years were studied retrospectively. The primary outcome was a composite of 30-day major complications based on MVARC definitions.
RESULTS
745 patients underwent minimally invasive mitral valve surgery (507 repair, 238 replacement), with a mean age of 62.9±12.3 years. The repair was successful in 95.8%. Overall 30-day mortality was 1.2% and stroke rate 0.3%. Freedom from any 30-day major complications was 87.2%, and independent predictors were left ventricular ejection fraction <50% (OR 1.78; 95% CI 1.02 to 3.02) and estimated glomerular filtration rate <60 mL/min/1.73 m (OR 1.98; 95% CI 1.17 to 3.26).
CONCLUSIONS
Minimally invasive mitral valve surgery is a safe technique and is associated with low 30-day mortality and stroke rate.
目的
在全球许多中心，微创手术越来越多地被用作二尖瓣病变传统胸骨切开术的替代方法。目前缺乏基于二尖瓣学术联盟（MVARC）标准预先指定的30天并发症综合清单的系统安全性分析。本研究的目的是基于MVARC定义系统分析我们中心微创二尖瓣手术的安全性。
方法
回顾性研究了我们机构10年内所有通过右胸小切口接受微创二尖瓣手术的连续患者。主要结局是基于MVARC定义的30天主要并发症的综合情况。
结果
745例患者接受了微创二尖瓣手术（507例修复，238例置换），平均年龄62.9±12.3岁。修复成功率为95.8%。30天总体死亡率为1.2%，卒中率为0.3%。无任何30天主要并发症的比例为87.2%，独立预测因素为左心室射血分数<50%（OR 1.78；95%CI 1.02至3.02）和估计肾小球滤过率<60 mL/min/1.73 m²（OR 1.98；95%CI 1.17至3.26）。
结论
微创二尖瓣手术是一种安全的技术，30天死亡率和卒中率较低。
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