Nguyen Quynh, Al-Hakim Durr, Cook Richard C
Division of Cardiac Surgery, Department of Surgery, University of British Columbia, Vancouver, BC V6Z 1Y6, Canada.
School of Biomedical Engineering, University of British Columbia, Vancouver, BC V6T 1Z4, Canada.
J Pers Med. 2025 Aug 4;15(8):353. doi: 10.3390/jpm15080353.
: Minimally invasive cardiac surgery (MICS) via right minithoracotomy is a safe, reproducible approach with excellent outcomes and reduced costs compared to median sternotomy. Despite careful patient selection, conversion to sternotomy occurs in 1-3% of cases and is associated with significantly higher morbidity and mortality. Small body habitus, particularly a short anteroposterior (AP) diameter, may increase the risk of conversion, but this has not been previously studied. This study aims to identify preoperative factors associated with conversion to improve patient selection for MICS. As cardiovascular surgery becomes increasingly personalized, identifying anatomical factors that predict technical complexity is essential. : This retrospective study included 254 adult patients who underwent elective MICS between 2015 and 2024 at a tertiary hospital. Patient characteristics, computed tomography (CT) scans, intraoperative parameters, and postoperative outcomes were reviewed. AP diameter was defined as the distance from the posterior sternum to the anterior vertebral body at the mitral valve level on CT. Statistical analyses included Mann-Whitney and Fisher's exact/chi-square tests. : Conversion to sternotomy occurred in 1.6% of patients (n = 4). All converted patients were female. The converted group had a significantly shorter median AP diameter (100 mm vs. 124 mm, = 0.020). Conversion was associated with higher rates of stroke and infection (25.0% vs. 0.8%, = 0.047 for both), but no significant differences in hospital stay, bleeding, or renal failure. An AP diameter of less than 100 mm was associated with a higher risk of conversion to sternotomy in MICS. Incorporating simple, reproducible preoperative imaging metrics into surgical planning may advance precision-guided cardiac surgery and optimize patient outcomes.
与正中开胸术相比，经右胸小切口的微创心脏手术（MICS）是一种安全、可重复的方法，具有良好的效果且成本降低。尽管进行了仔细的患者选择，但仍有1% - 3%的病例需要转为开胸手术，且其发病率和死亡率显著更高。体型较小，尤其是前后径较短，可能会增加转为开胸手术的风险，但此前尚未对此进行研究。本研究旨在确定与转为开胸手术相关的术前因素，以改善MICS患者的选择。随着心血管手术越来越个性化，识别预测技术复杂性的解剖因素至关重要。 这项回顾性研究纳入了2015年至2024年在一家三级医院接受择期MICS的254例成年患者。回顾了患者特征、计算机断层扫描（CT）、术中参数和术后结果。AP直径定义为CT上二尖瓣水平后胸骨到前椎体的距离。统计分析包括Mann-Whitney检验和Fisher精确/卡方检验。 1.6%的患者（n = 4）转为开胸手术。所有转为开胸手术的患者均为女性。转为开胸手术组的中位AP直径明显较短（100 mm对124 mm，P = 0.020）。转为开胸手术与中风和感染发生率较高相关（均为各25.0%对0.8%，P = 0.047），但在住院时间、出血或肾衰竭方面无显著差异。MICS中AP直径小于100 mm与转为开胸手术的风险较高相关。将简单、可重复的术前影像指标纳入手术规划可能会推动精准引导心脏手术并优化患者预后。
