Cardiovascular Surgery Department, Mohammed VI University Hospital, Marrakech, Morocco.
Pan Afr Med J. 2021 Sep 30;40:68. doi: 10.11604/pamj.2021.40.68.28008. eCollection 2021.
aortic valve replacement is usually performed through a median full sternotomy (MFS) in our department. Minimally invasive aortic valve replacement (MIAVR) has been recently adopted as a new approach. According to the literature, the superiority of MIAVR is controversial. In this study we report early post-operative outcomes in MIAVR compared with MFS access with reference to blood Loss, wound infections, post-operative recovery, morbidity and mortality.
this study was a prospective data collection from 36 consecutive patients undergoing isolated valve replacement. Two population study was identified, MIAVR group (group I n=18) and MFS group (group II n=18). Patients´ data were collected and analyzed using IBM SPSS statistics 21 software and Khi2 test has been used to compare the variables. The study variables are presented as numbers, percentage, median with interquartile range. Pre-operative planning was performed so that to obtain similar characteristics.
in group I, upper mini-sternotomy was used in 12 patients and right mini-thoracotomy in 6 patients. There was no difference in term of mortality and morbidity. MIAVR was associated with longer CPB time (93.25 (58-161) vs 131 (75-215) mins, P=0.047) with no significant difference in term of ACC time (81 (33-162) vs 58.8 (59-102) mins P=0.158). MIAVR´ Patients had likely lower incidence of red blood cells transfusion (16.7 vs 52.3%) without significant difference about post-operative haemoglobin (P = 0,330). Patients in group I had shorter ventilation time (2.35 (1-12) vs 9.3 (1-48) hours P < 0.01), shorter ICU stay (2.44 (1-8) vs 4.25 (1-9) days, P = 0,024). The length of hospital stay was shorter, 6.5 (5-9) days in group I vs 7.4 (6-11), P=0.0274. Length of chest tube stay was shorter in group I (mean 1.53 vs 2.4 days, P=0,033). Wound infections were not found in both groups.
minimally invasive aortic valve replacement is associated with less blood loss, faster post-operative recovery faster post-operative recovery but increase operation time.
在我院，主动脉瓣置换术通常通过正中胸骨切开术（MFS）进行。微创主动脉瓣置换术（MIAVR）最近已被采用为一种新方法。根据文献，MIAVR 的优越性存在争议。在这项研究中，我们报告了与 MFS 相比，MIAVR 术后早期的转归，包括失血量、伤口感染、术后恢复、发病率和死亡率。
这是一项前瞻性收集 36 例连续接受单纯瓣膜置换术患者的数据的研究。确定了两组人群研究，MIAVR 组（I 组，n=18）和 MFS 组（II 组，n=18）。使用 IBM SPSS Statistics 21 软件收集和分析患者数据，并使用 Khi2 检验比较变量。研究变量以数字、百分比、中位数（四分位距）表示。进行术前规划，以获得相似的特征。
在 I 组中，12 例采用上小开胸术，6 例采用右小开胸术。两组在死亡率和发病率方面无差异。MIAVR 与更长的 CPB 时间相关（93.25（58-161）vs 131（75-215）min，P=0.047），但 ACC 时间无显著差异（81（33-162）vs 58.8（59-102）min，P=0.158）。MIAVR 患者的红细胞输血发生率较低（16.7% vs 52.3%），但术后血红蛋白无显著差异（P=0.330）。I 组患者的通气时间更短（2.35（1-12）vs 9.3（1-48）h，P<0.01），ICU 住院时间更短（2.44（1-8）vs 4.25（1-9）d，P=0.024）。I 组患者的住院时间更短，6.5（5-9）d 与 7.4（6-11）d，P=0.0274。I 组的胸腔引流管留置时间更短（平均 1.53 与 2.4 天，P=0.033）。两组均未发现伤口感染。
微创主动脉瓣置换术与失血量减少、术后恢复更快相关，但手术时间延长。
