微创主动脉瓣手术

Minimally invasive aortic valve surgery.

作者信息

Di Bacco Lorenzo, Miceli Antonio, Glauber Mattia

机构信息

U.O. Cardiochirurgia Mininvasiva, Istituto Clinico Sant'Ambrogio, Gruppo San Donato, Milano, Italy.

出版信息

J Thorac Dis. 2021 Mar;13(3):1945-1959. doi: 10.21037/jtd-20-1968.

Abstract

Since their introduction, it has been demonstrated that minimally invasive aortic valve replacement (MIAVR) approaches are safe and effective for the treatment of aortic valve diseases. To date, the main advantage of these approaches is represented by the reduced surgical trauma, with a subsequent reduced complication rate and faster recovery. This makes such approaches an appealing choice also for frail patients [obese, aged, chronic obstructive pulmonary disease (COPD)]. The standardization of the minimally invasive techniques, together with the implementation of preoperative workup and anesthesiological intra- and post-operative care, led to an amelioration of surgical results and reduction of surgical times. Moreover, the improvement of surgical technology and the introduction of new devices such as sutureless and rapid deployment (SURD) valves, has helped the achievement of comparable results to traditional surgery. However, transcatheter technologies are nowadays more and more important in the treatment of aortic valve disease, also in low risk patients. For this reason surgeons should put new efforts for further reducing the surgical trauma in the future, even taking inspiration from other disciplines. In this review, we aim to present a review of literature evidences regarding minimally invasive treatment of aortic diseases, also reflecting our personal experience with MIAVR techniques. This review could represent a tool for a well-structured patient assessment and preoperative planning, in order to safely carrying out an MIAVR procedure with satisfactory outcomes.

摘要

自引入以来,已证明微创主动脉瓣置换术(MIAVR)方法在治疗主动脉瓣疾病方面是安全有效的。迄今为止,这些方法的主要优势在于手术创伤减小,并发症发生率随之降低,恢复更快。这使得这些方法对于体弱患者(肥胖、老年、慢性阻塞性肺疾病(COPD))也是一个有吸引力的选择。微创技术的标准化,以及术前检查和麻醉术中及术后护理的实施,使手术结果得到改善,手术时间缩短。此外,手术技术的改进以及无缝合和快速部署(SURD)瓣膜等新设备的引入,有助于取得与传统手术相当的结果。然而,如今经导管技术在主动脉瓣疾病的治疗中越来越重要,即使在低风险患者中也是如此。因此,外科医生未来应进一步努力进一步减少手术创伤,甚至从其他学科中汲取灵感。在本综述中,我们旨在对关于主动脉疾病微创治疗的文献证据进行综述,同时也反映我们在MIAVR技术方面的个人经验。本综述可作为一个工具,用于进行结构良好的患者评估和术前规划,以便安全地进行MIAVR手术并获得满意的结果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5887/8024826/806c65ba73d5/jtd-13-03-1945-f1.jpg

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