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微创三尖瓣手术

Minimally invasive tricuspid valve surgery.

作者信息

Abdelbar Abdelrahman, Kenawy Ayman, Zacharias Joseph

机构信息

Department of Cardiothoracic surgery, Lancashire Heart Centre, Blackpool Teaching Hospital, Blackpool, UK.

出版信息

J Thorac Dis. 2021 Mar;13(3):1982-1992. doi: 10.21037/jtd-20-1331.

Abstract

Tricuspid valve disease carries a very unfavorable prognosis when medically treated. Despite that, surgical intervention is still underperformed for tricuspid valve disease due to the reported high morbidity and mortality from a sternotomy approach. This had led to a shift towards maximizing medical therapy for right ventricular failure and, as a result, a more significant delay in surgical referrals with surgical risks when patients are finally referred. Tricuspid valve patients usually have other co-morbidities resulting from their systemic venous congestion and low flow cardiac output. Minimally invasive tricuspid valve surgery provides less tissue injury and, as a result, less trauma during surgery. This provides a hope for both patients and treating doctors to be more open for providing this procedure with less complications. Isolated minimally invasive tricuspid valve surgery is still not performed as widely as expected. This can be partly due to the adverse outcomes historically labelled to tricuspid valve surgery or by the long journey of learning the surgical team would need to commit to with a minimal access approach. In this article we will review the perioperative pathway, and outcomes of isolated minimally invasive tricuspid valve surgery in the available English literature.

摘要

三尖瓣疾病接受药物治疗时预后非常不佳。尽管如此,由于据报道胸骨切开术方法的发病率和死亡率较高,三尖瓣疾病的外科干预仍然实施不足。这导致了向最大限度地采用药物治疗右心室衰竭的转变,结果是当患者最终转诊时,手术转诊的延迟更为显著,且存在手术风险。三尖瓣疾病患者通常因体循环静脉淤血和低心排血量而伴有其他合并症。微创三尖瓣手术造成的组织损伤较小,因此手术期间的创伤也较小。这为患者和治疗医生更愿意接受该手术且减少并发症带来了希望。单纯的微创三尖瓣手术的开展仍未达到预期的广泛程度。这部分可能是由于历史上三尖瓣手术被标记的不良后果,或者是手术团队需要通过微创入路进行漫长的学习过程。在本文中,我们将回顾现有英文文献中单纯微创三尖瓣手术的围手术期路径及结果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d49e/8024798/3873107aceb1/jtd-13-03-1982-f1.jpg

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