Pham Thanh Dat, Tran Thanh Huyen, Le Ngoc Thanh, Nguyen Cong Huu
Departement of Cardiovascular and Thoracic Surgery, E Hospital, Hanoi, Vietnam, University of Medicine and Pharmacy - Vietnam National University, Hanoi, Vietnam.
Saint Paul General Hospital, Hanoi, Vietnam.
J Cardiothorac Surg. 2025 Jan 6;20(1):28. doi: 10.1186/s13019-024-03250-4.
.Endoscopic mitral valve repair has progressively been adopted as the standard approach for treating isolated mitral regurgitation across numerous renowned cardiac surgery centers worldwide. Our innovative method for mitral valve exposure has been previously described. This study evaluates the outcomes of totally endoscopic mitral valve repair using this advanced technique over a five-year period at a single center.
. A retrospective review was conducted on 122 patients who underwent totally endoscopic mitral valve repair between May 2018 and December 2023. Clinical and echocardiographic data were meticulously collected and analyzed. The surgical procedure was performed completely endoscopic via a 3-4 cm right mini-thoracotomy, with peripheral cardiopulmonary bypass. A specialized technique utilizing retraction sutures for mitral valve exposure was employed. Primary outcomes included the results of the endoscopic techniques, mitral valve repair outcomes, perioperative complications, and short-term mortality. Long-term outcomes, including survival, freedom from reoperation, and recurrent mitral regurgitation, were assessed using Kaplan-Meier analysis.
. Mitral valve exposure was successfully achieved in all cases. The mean age of the patients was 54.5 ± 14.2 years, and their mean log EuroSCORE II was 1.53 ± 1.30. The repair rate was 96%, with anterior leaflet repair in 13%, posterior leaflet repair in 69%, and bileaflet repair in 14%. Mean aortic cross-clamp time and cardiopulmonary bypass time were 117 ± 39 min and 181 ± 48 min, respectively. The early mortality rate was 1.6%. Three patients (2.5%) experienced intraoperative conversion to sternotomy and 6 patients (4.9%) underwent a reoperation. There were 2 cases of stroke (1.6%) and 2 cases of unilateral pulmonary edema (1.6%). The minimum follow-up duration for a patient was 6 months, extending up to 72 months, with a mean follow-up duration of 28.6 ± 15.1 months. Kaplan-Meier analysis demonstrated a 96.7 ± 1.6% survival rate at 5 years, with 98.4 ± 1.2% freedom from reoperation, and 86.1 ± 3.1% freedom from recurrent mitral regurgitation.
. Totally endoscopic mitral valve repair utilizing the novel technique of left atrial exposure is feasible and can be safely performed with low mortality and morbidity. This approach achieves a high rate of mitral repair and demonstrates favorable long-term outcomes.
内镜下二尖瓣修复术已逐渐被全球众多著名心脏外科中心采用，作为治疗单纯二尖瓣反流的标准方法。我们此前已描述过创新的二尖瓣暴露方法。本研究评估了在单一中心使用这种先进技术进行全内镜二尖瓣修复术五年期间的结果。
对2018年5月至2023年12月期间接受全内镜二尖瓣修复术的122例患者进行回顾性研究。精心收集并分析临床和超声心动图数据。手术通过3 - 4厘米的右胸小切口完全在内镜下进行，采用外周体外循环。采用一种利用牵引缝线进行二尖瓣暴露的专门技术。主要结果包括内镜技术的结果、二尖瓣修复结果、围手术期并发症和短期死亡率。使用Kaplan - Meier分析评估长期结果，包括生存率、再次手术率和二尖瓣反流复发率。
所有病例均成功实现二尖瓣暴露。患者的平均年龄为54.5±14.2岁，平均欧洲心脏手术风险评估系统（EuroSCORE）II评分为1.53±1.30。修复率为96%，其中前叶修复占13%，后叶修复占69%，双叶修复占14%。平均主动脉阻断时间和体外循环时间分别为117±39分钟和181±48分钟。早期死亡率为1.6%。3例患者（2.5%）术中转为胸骨切开术，6例患者（4.9%）接受再次手术。有2例中风（1.6%）和2例单侧肺水肿（1.6%）。患者的最短随访时间为6个月，最长达72个月，平均随访时间为28.6±15.1个月。Kaplan - Meier分析显示，5年生存率为96.7±1.6%，再次手术率为98.4±1.2%，二尖瓣反流复发率为86.1±3.1%。
采用左心房暴露新技术的全内镜二尖瓣修复术是可行的，并且可以安全进行，死亡率和发病率较低。这种方法实现了较高的二尖瓣修复率，并显示出良好的长期效果。
