Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Interact Cardiovasc Thorac Surg. 2022 Feb 21;34(3):354-360. doi: 10.1093/icvts/ivab309.
Right mini-thoracotomy approach may enhance the visualization of mitral valve (MV) visualization during redo MV surgery, thereby minimizing the risk of reoperative median sternotomy. We described the clinical outcomes of redo MV surgery by mini-thoracotomy and full-sternotomy approach.
Of 730 consecutive adult patients who underwent redo MV surgery between 2002 and 2018 at our institution, we identified 380 patients (age: 56.0 [14.8] years) after excluding those who underwent concomitant aortic valve or coronary artery surgeries.
The clinical outcomes in patients who underwent mini-thoracotomy (MINI group; n = 168) and full-sternotomy (STERN group; n = 218) were described. The early and overall mortality in the MINI group was 4.3% (7/162) and 17.3% (28/162), with the rates of early major complications as follows: low cardiac output syndrome, 5.6% (9/162); early stroke, 6.8% (11/162); new-onset dialysis, 6.2% (10/162); prolonged ventilation, 15.4% (25/162); and postoperative bleeding requiring exploration, 7.4% (12/162). In the STERN group, the early mortality was 11.0% (24/218), whereas the risk of low cardiac output syndrome, early stroke, new-onset dialysis, prolonged ventilation, and postoperative bleeding was 12.4% (27/218), 14.2% (31/218), 17.0% (37/218), 33.0% (72/218), and 10.1% (22/218), respectively. The duration of intensive care unit and hospital stay was 2.0 [range 1.0, 3.0] and 8.0 [6.0, 13.0], respectively, in the MINI group and 3.0 [2.0, 7.0] and 14.0 [8.0, 29.0], respectively, in the STERN group.
Mini-thoracotomy may be a viable alternative to conventional sternotomy for redo MV surgery.
右小开胸术可能会增强二尖瓣（MV）在二尖瓣再手术中的可视化效果，从而最大限度地降低再次正中开胸的风险。我们描述了通过小开胸和全胸骨切开术进行二尖瓣再手术的临床结果。
在我们机构于 2002 年至 2018 年间连续进行的 730 例成人患者中，排除了同时进行主动脉瓣或冠状动脉手术的患者后，我们确定了 380 例患者（年龄：56.0[14.8]岁）。
描述了接受小开胸（MINI 组；n=168）和全胸骨切开（STERN 组；n=218）的患者的临床结果。MINI 组的早期和总死亡率分别为 4.3%（7/162）和 17.3%（28/162），早期主要并发症的发生率如下：低心输出量综合征，5.6%（9/162）；早期中风，6.8%（11/162）；新发透析，6.2%（10/162）；延长通气，15.4%（25/162）；术后出血需探查，7.4%（12/162）。在 STERN 组中，早期死亡率为 11.0%（24/218），而低心输出量综合征、早期中风、新发透析、延长通气和术后出血的风险分别为 12.4%（27/218）、14.2%（31/218）、17.0%（37/218）、33.0%（72/218）和 10.1%（22/218）。MINI 组 ICU 住院时间和住院时间分别为 2.0[1.0，3.0]和 8.0[6.0，13.0]，而 STERN 组分别为 3.0[2.0，7.0]和 14.0[8.0，29.0]。
小开胸术可能是二尖瓣再手术的一种可行的替代传统胸骨切开术的方法。
