The Keyhole Heart Centre, Netcare Blaauwberg Hospital, Cape Town 7441, South Africa.
Cardiovascular Surgery, Cardiovascular Centre, OLV Clinic, 9300 Aalst, Belgium.
Medicina (Kaunas). 2023 Aug 16;59(8):1470. doi: 10.3390/medicina59081470.
The devastating impact of a circumflex coronary artery (CX) injury during mitral valve (MV) surgery is well reported. Despite significant improvements in preoperative risk assessment, intraoperative diagnosis and perioperative treatment strategies of CX injury during MV surgery, recent reports re-emphasize the variability in presentation, the unpredictable mechanisms of injury and the conflicting evidence regarding perioperative management. The progressive transition from conventional sternotomy access to minimally invasive surgical and transcatheter (TC) interventions for MV disease are associated with significant learning curves and require additional single-shaft and robotic console suture manipulation skills with special attentiveness to the potential risk of CX injury. The introduction of hybrid theatres that facilitate single stage surgical and TC interventions also provides new intraoperative diagnostic and therapeutic options without transporting unstable patients for percutaneous coronary intervention (PCI) assessment. By utilizing a MeSH terms-based PubMed search, a total of 89 patients with CX injury that occurred during MV surgery was identified from 49 reports between 1967 and 2022. MV surgery was performed by conventional sternotomy ( = 76, 85.4%), endoscopic ( = 12, 13.4%) and robotic access ( = 1, 1.1%), with 35 injuries (39.3%) resulting in total CX occlusion. Rescue PCI was utilized in 40 patients (44.9%). This manuscript provides a systematic overview of all available historic and contemporary reports on CX injury during MV surgery, outlines recent refinements in CX injury mechanisms, describes current MV surgery associated CX injury prevention and diagnosis and treatment strategies and highlights important MV procedural aspects that may minimize the risk and consequences of CX injury.
回旋支冠状动脉（CX）损伤在二尖瓣（MV）手术中的破坏性影响已有相关报道。尽管 MV 手术中 CX 损伤的术前风险评估、术中诊断和围手术期治疗策略有了显著的改进，但最近的报告再次强调了 CX 损伤的临床表现多变、损伤机制难以预测以及围手术期处理策略存在相互矛盾的证据。从传统的胸骨切开术入路到微创外科和经导管（TC）介入治疗 MV 疾病的逐步转变，与显著的学习曲线相关，需要额外的单轴和机器人控制台缝线操作技能，并特别注意 CX 损伤的潜在风险。杂交手术室的引入为单一阶段的外科和 TC 干预提供了新的术中诊断和治疗选择，而无需将不稳定的患者转运至进行经皮冠状动脉介入治疗（PCI）评估。通过使用基于 MeSH 术语的 PubMed 搜索，从 1967 年至 2022 年的 49 份报告中确定了 89 例 MV 手术中发生的 CX 损伤患者。MV 手术通过传统的胸骨切开术（=76，85.4%）、内镜（=12，13.4%）和机器人入路（=1，1.1%）进行，其中 35 例（39.3%）导致 CX 完全闭塞。40 例患者（44.9%）采用了经皮冠状动脉介入治疗（PCI）。本文对所有关于 MV 手术中 CX 损伤的历史和当代报告进行了系统综述，概述了 CX 损伤机制的最新改进，描述了当前与 MV 手术相关的 CX 损伤预防、诊断和治疗策略，并强调了可能最小化 CX 损伤风险和后果的重要 MV 手术方面。
