Boyle Mark, Elfadil Ahmed, Mirsadraee Saeed, Bahrami Toufan
Department of Surgery and Cancer, Imperial College, London, UK.
Department of Cardiothoracic Surgery, Royal Victoria Hospital, Belfast, UK.
Interdiscip Cardiovasc Thorac Surg. 2025 May 6;40(5). doi: 10.1093/icvts/ivaf106.
Mitral valve surgery has undergone significant advancements with the emergence of minimally invasive mitral surgery harnessing endoscopic technology to facilitate repair through a right anterior thoracotomy. Further refinement within the field has borne the novel totally endoscopic approach, reducing incision size, and surgical trauma, to 3 cm. While there is evidence to support non-inferiority of minimally invasive techniques compared to a traditional sternotomy, a knowledge gap exists regarding the comparative safety and efficacy between minimally invasive modalities, necessitating.
A retrospective review of outcomes following totally endoscopic and minimally invasive mitral valve surgery by right anterior thoracotomy was completed. One hundred eighty-six patients were included, all operations having been performed by a single surgeon, between January 2019 and June 2023. The hypothesis posits that the former offers an equivalence in repair while reducing postoperative pain, bleeding from the wound and enhancing cosmesis.
While low 30-day mortality rates were seen in both cohorts, the totally endoscopic group exhibited lower rates of patients discharged with opiates (16% vs 23%), reduced blood product transfusion requirements (33% vs 43%) and shorter postoperative stays (mean of 9.2 days vs 11.4 days).
Moving from minimally invasive to totally endoscopic mitral valve surgery has been a positive experience with key patient advantages characterized by smaller incisions and avoidance of rib spreading. In this dataset, improved patient outcomes such as postoperative bleeding, pain, length of hospital stay and cosmesis were observed with all limitations given its fully uncontrolled nature. Validation of these findings warrants a larger study.
随着微创二尖瓣手术的出现，二尖瓣手术取得了重大进展，该手术利用内镜技术通过右前开胸进行修复。该领域的进一步改进产生了全新的全内镜手术方法，将切口大小和手术创伤减小至3厘米。虽然有证据支持微创技术与传统胸骨切开术相比具有非劣效性，但在微创术式之间的比较安全性和疗效方面存在知识空白，因此有必要进行研究。
对通过右前开胸进行的全内镜和微创二尖瓣手术的结果进行了回顾性研究。纳入了186例患者，所有手术均由同一外科医生在2019年1月至2023年6月期间完成。该假设认为，前者在修复方面具有等效性，同时可减轻术后疼痛、伤口出血并改善美容效果。
虽然两个队列的30天死亡率都很低，但全内镜组使用阿片类药物出院的患者比例较低（16%对23%），血液制品输注需求减少（33%对43%），术后住院时间更短（平均9.2天对11.4天）。
从微创二尖瓣手术转向全内镜二尖瓣手术是一次积极的经历，对患者具有关键优势，其特点是切口更小且避免肋骨撑开。在这个数据集中，观察到患者术后出血、疼痛、住院时间和美容效果等方面有所改善，但鉴于其完全不受控制的性质，存在所有局限性。这些发现的验证需要更大规模的研究。
