微创二尖瓣手术：右前外侧小切口开胸术后长期（20年）随访
Minimally Invasive Mitral Valve Surgery: Long-Term (20-Year) Follow-Up After Right Anterolateral Minithoracotomy.
作者信息
Salem Razan, Fay Katharina, Kaiser Philipp, Karimian-Tabrizi Afsaneh, Herrmann Eva, Winter Andreas, Hlavicka Jan, Hecker Florian, Moritz Anton, Walther Thomas, Holubec Tomas
机构信息
Department of Cardiovascular Surgery, University Hospital and Goethe University Frankfurt, Frankfurt/Main, Germany.
Department of Anesthesiology, Varisano Clinic Frankfurt Höchst, Frankfurt/Main, Germany.
出版信息
CJC Open. 2025 Feb 6;7(7):879-886. doi: 10.1016/j.cjco.2025.02.001. eCollection 2025 Jul.
BACKGROUND
Minimally invasive mitral valve (MV) surgery (MIMVS) through right lateral minithoracotomy has evolved as the standard approach for most patients. Data on long-term functional outcomes, however, are rare. We evaluated long-term outcomes after MIMVS through right minithoracotomy for up to 21.6 years.
METHODS
From 1997 to 2017, 301 patients with a median age of 57 years (range, 20-81; 54.5% female) underwent MIMVS through right anterolateral minithoracotomy. Follow-up data were evaluated using Kaplan-Meier analyses and competing risk analysis.
RESULTS
A total of 249 patients (82.7%) underwent MV repair, and 52 (17.2%) received valve replacement. Conversion to sternotomy was required in 2 patients (0.8%), and 2 patients (0.8%) suffered perioperative stroke. The 30-day mortality rate was 3.3%. During follow-up, 21 patients required MV reoperation after a mean period of 21.6 ± 0.2 years. The cumulative incidence of reoperation at 5, 10, 15, and 20 years, respectively, was 2.0% ± 0.8%, 4.5% ± 1.2%, 6.0% ± 1.4%, and 7.0% ± 1.6%. The cumulative incidence of recurrent mitral regurgitation ≥ moderate at 5, 10, 15, and 20 years, respectively, was 4.5% ± 1.2%, 11.1% ± 1.9%, 16.4% ± 2.2%, and 20.2% ± 2.7%. The 10- and 20-year survival of all patients was 83.6% ± 2% and 55.0% ± 4%, respectively.
CONCLUSIONS
MIMVS can be performed safely with very good perioperative outcomes, a low incidence of mortality, and excellent long-term valve performance.
背景
经右外侧小切口的微创二尖瓣手术（MIMVS）已发展成为大多数患者的标准术式。然而，关于其长期功能结局的数据却很罕见。我们评估了经右小切口行MIMVS长达21.6年的长期结局。
方法
1997年至2017年，301例患者（中位年龄57岁，范围20 - 81岁；54.5%为女性）经右前外侧小切口接受了MIMVS。采用Kaplan-Meier分析和竞争风险分析对随访数据进行评估。
结果
共有249例患者（82.7%）接受了二尖瓣修复，52例（17.2%）接受了瓣膜置换。2例患者（0.8%）需要转为胸骨正中切开术，2例患者（0.8%）发生围手术期卒中。30天死亡率为3.3%。在随访期间，21例患者在平均21.6±0.2年的时间后需要再次进行二尖瓣手术。5年、10年、15年和20年再次手术的累积发生率分别为2.0%±0.8%、4.5%±1.2%、6.0%±1.4%和7.0%±1.6%。5年、10年、15年和20年二尖瓣反流复发≥中度的累积发生率分别为4.5%±1.·2%、11.1%±1.9%、16.4%±2.2%和20.2%±2.7%。所有患者10年和20年生存率分别为83.6%±2%和55.0%±4%。
结论
MIMVS可以安全进行，围手术期结局良好，死亡率低，长期瓣膜功能优良。
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