Division of Thoracic and Cardiovascular Surgery, University of Tübingen, 72076 Tübingen, Germany.
Department of Cardiovascular Surgery, University Hospital Frankfurt, Johann Wolfgang Goethe University Frankfurt, 60590 Frankfurt am Main, Germany.
Medicina (Kaunas). 2021 Oct 30;57(11):1179. doi: 10.3390/medicina57111179.
Minimally invasive mitral valve (MV) surgery has emerged as an alternative to conventional sternotomy aiming to decrease surgical trauma. The aim of the study was to describe our experience with minimally invasive MV surgery through partial upper sternotomy (PUS) regarding short- and long-term outcomes. From January 2004 through March 2014, 419 patients with a median age of 58.9 years (interquartile range 18.7; 31.7% females) underwent isolated primary MV surgery using PUS. Myxomatous degenerative MV disease was the predominant pathology (77%). The patients' mean EuroSCORE II risk profile was 3.9 ± 3.6%. Mitral valve repair was performed in 384 patients (91.6%) and replacement in 35 patients (8.4%). Thirty-day mortality was 3.1%. In total, 29 (6.9%) deaths occurred during the follow-up. The overall estimated survival at 1, 5, and 10 years was 93.1 ± 1.3%, 87.1 ± 1.9%, and 81.1 ± 3.4%. Reoperation was necessary in 14 (3.3%) patients. The overall freedom from MV reoperation at 1, 5, and 10 years was 98.2 ± 0.7%, 96.1 ± 1.2%, and 86.7 ± 6.7% and the overall freedom from recurrent MV regurgitation > grade 2 in repaired valves at 1, 5, and 10 years was 98.8 ± 0.6%, 98.8 ± 0.6%, and 94.6 ± 3.3%. Minimally invasive MV surgery via PUS can be performed with particularly good early and late results. Thus, the PUS approach with the use of standard surgical instruments and cannulation techniques can be a valuable option for the MV surgery either in patients contraindicated or not suitable to minithoracotomy.
经胸骨上段小切口（PUS）的微创二尖瓣（MV）手术已成为一种替代传统胸骨切开术的方法，旨在减少手术创伤。本研究旨在通过经胸骨上段小切口行微创 MV 手术的短期和长期结果来描述我们的经验。2004 年 1 月至 2014 年 3 月，419 例中位年龄为 58.9 岁（四分位距 18.7；31.7%为女性）的患者接受了经胸骨上段小切口的原发性 MV 手术。MV 病变主要为黏液瘤样退行性变（77%）。患者的平均 EuroSCORE II 风险评分是 3.9 ± 3.6%。384 例（91.6%）患者行 MV 修复，35 例（8.4%）行 MV 置换。30 天死亡率为 3.1%。随访期间共有 29 例（6.9%）死亡。1、5 和 10 年总体生存率分别为 93.1 ± 1.3%、87.1 ± 1.9%和 81.1 ± 3.4%。共有 14 例（3.3%）患者需再次手术。1、5 和 10 年的 MV 再次手术无失败率分别为 98.2 ± 0.7%、96.1 ± 1.2%和 86.7 ± 6.7%，1、5 和 10 年的修复瓣膜复发性 MV 反流＞2 级的无失败率分别为 98.8 ± 0.6%、98.8 ± 0.6%和 94.6 ± 3.3%。经胸骨上段小切口的微创 MV 手术可获得良好的早期和晚期结果。因此，使用标准手术器械和插管技术的胸骨上段小切口入路对于那些不能耐受或不适合小开胸的 MV 手术的患者是一种有价值的选择。
