Monsefi Nadejda, Öztürk Mahmut, Shavahatli Tunjay, Bakhtiary Farhad
Department of Cardiothoracic Surgery, Helios Heart Center NRW, Siegburg-Wuppertal, University of Witten Herdecke, Witten, Germany.
Indian J Thorac Cardiovasc Surg. 2020 Nov;36(6):591-597. doi: 10.1007/s12055-020-01027-7. Epub 2020 Aug 20.
A minimally invasive technique is an attractive option in cardiac surgery. In this study, we present our experience with minimally invasive cardiac surgery (MICS) via right mini-thoracotomy on patients undergoing mitral valve procedure as reoperation.
From 2017 until 2019, 20 patients underwent reoperation of the mitral valve through a right-sided mini-thoracotomy. Cardiopulmonary bypass was established through cannulation of the femoral vessels. All patients requiring isolated re-operative mitral valve surgery with suitable femoral vessels for cannulation were included in the study. Patients requiring concomitant coronary artery bypass grafting (CABG) or with peripheral artery disease were excluded.
The mean age was 65 ± 12 years. The average log. EuroSCORE was 9 ± 5%. Ten patients with severe mitral valve regurgitation (MR) underwent re-repair of the mitral valve. Seven of them were post mitral valve repair (MVR), one was post aortic valve replacement (AVR), one had tricuspid valve repair, and one other patient had CABG before. Ten patients underwent mitral valve replacement due to mixed mitral valve disease ( = 9) or mitral valve endocarditis ( = 1). Eight patients were post MVR and 2 had AVR before. The mean time to reoperation was 7.5 ± 8 years. In-hospital mortality was 5% ( = 1). The mean cross clamp time was 54 ± 26 min. Postoperative echocardiography revealed competent valve function in all cases with mean ejection fraction of 55 ± 9%. The Kaplan-Meier 1- and 2-year survival was 95%.
The MICS approach for mitral valve reoperation in selected patients seems to be safe and feasible. It is also a surgical option for high-risk patients.
微创技术在心脏手术中是一个有吸引力的选择。在本研究中，我们介绍了经右胸小切口对二尖瓣手术再手术患者进行微创心脏手术（MICS）的经验。
2017年至2019年，20例患者通过右侧胸小切口进行二尖瓣再手术。通过股血管插管建立体外循环。所有需要单纯再次二尖瓣手术且股血管适合插管的患者均纳入本研究。需要同期冠状动脉旁路移植术（CABG）或患有外周动脉疾病的患者被排除。
平均年龄为65±12岁。平均欧洲心脏手术风险评估系统（EuroSCORE）评分为9±5%。10例重度二尖瓣反流（MR）患者接受了二尖瓣再次修复。其中7例为二尖瓣修复（MVR）术后，1例为主动脉瓣置换（AVR）术后，1例进行了三尖瓣修复，另1例患者之前进行过CABG。10例患者因二尖瓣混合病变（n = 9）或二尖瓣心内膜炎（n = 1）接受了二尖瓣置换。8例为MVR术后，2例之前进行过AVR。再次手术的平均时间为7.5±8年。住院死亡率为5%（n = 1）。平均阻断时间为54±26分钟。术后超声心动图显示所有病例瓣膜功能良好，平均射血分数为55±9%。Kaplan-Meier 1年和2年生存率为95%。
对于选定患者，MICS方法用于二尖瓣再手术似乎是安全可行的。它也是高危患者的一种手术选择。
