Evseev E P, Balakin E V, Aidamirov Ya A, Fomin M A, Ivanov V A, Belov Yu V
Petrovsky Russian Scientific Center of Surgery, Moscow, Russia.
Khirurgiia (Mosk). 2021(6. Vyp. 2):37-44. doi: 10.17116/hirurgia202106237.
To evaluate the early outcomes of surgical treatment of heart valve disease and cardiac tumors via the right-sided minithoracotomy.
There were 77 interventions via the right-sided minithoracotomy for the period from 2017 to March 2021 (29 men (37.7%) and 48 women (62.3%) aged 50.9±13 years (95% CI 48-53.9)). Heart failure NYHA class III prevailed (45.5%). The following interventions were performed: mitral valve replacement - 32 (41.5%) patients, mitral valve repair - 22 (28.6%) patients, atrial septal defect closure - 13 (16.9%) patients, resection of the left atrial myxoma - 4 (5.2%) patients, atrial septal defect closure + tricuspid valve repair - 2 (2.6%) patients, tricuspid valve replacement - 2 (2.6%) patients, mitral valve repair + atrial septal defect closure - 1 (2.6%) patient, mitral valve repair + atrial septal defect closure + right middle lobectomy - 1 (2.6%) patient.
There were no in-hospital mortality and major cardiac events. Conversion was required in 1 case (1.3%). Enlargement up conventional to thoracotomy was required in 1 case (1.3%). Surgery time was 217 min (Q1-Q3 188-258), cardiopulmonary bypass time - 106 min (Q1-Q3 91-124), aortic cross-clamping time - 82±29 min (95% CI 76-89). Intraoperative blood loss was 500 ml (Q1-Q3 400-600). Mean postoperative hospital-stay was 6.7±1.8 days (95% CI 6.3-7.1).
Heart valve surgery and resection of cardiac tumors via the right-sided minithoracotomy is a safe and effective approach to ensure chest stability, fast postoperative recovery and favorable cosmetic result. Surgery time is decreased along the learning curve.
评估经右侧小切口开胸手术治疗心脏瓣膜疾病和心脏肿瘤的早期疗效。
2017年至2021年3月期间，共进行了77例经右侧小切口开胸手术（男性29例（37.7%），女性48例（62.3%），年龄50.9±13岁（95%置信区间48 - 53.9））。纽约心脏病协会（NYHA）III级心力衰竭患者居多（45.5%）。实施了以下手术：二尖瓣置换术——32例（41.5%）患者，二尖瓣修复术——22例（28.6%）患者，房间隔缺损封堵术——13例（16.9%）患者，左心房黏液瘤切除术——4例（5.2%）患者，房间隔缺损封堵术 + 三尖瓣修复术——2例（2.6%）患者，三尖瓣置换术——2例（2.6%）患者，二尖瓣修复术 + 房间隔缺损封堵术——1例（2.6%）患者，二尖瓣修复术 + 房间隔缺损封堵术 + 右肺中叶切除术——1例（2.6%）患者。
无院内死亡及重大心脏事件。1例（1.3%）需要中转手术。1例（1.3%）需要扩大为传统开胸手术。手术时间为217分钟（第一四分位数 - 第三四分位数188 - 258），体外循环时间——106分钟（第一四分位数 - 第三四分位数91 - 124），主动脉阻断时间——82±29分钟（95%置信区间76 - 89）。术中失血500毫升（第一四分位数 - 第三四分位数400 - 600）。术后平均住院时间为6.7±1.8天（95%置信区间6.3 - 7.1）。
经右侧小切口开胸进行心脏瓣膜手术和心脏肿瘤切除是一种安全有效的方法，可确保胸部稳定性、术后快速恢复及良好的美容效果。手术时间会随着学习曲线而缩短。
