Frapier J M, Carabasse D, Seguin J R, Picard E, Meunier J P, Chaptal P A
Service de Chirurgie thoracique et cardiovasculaire, Hôpital Arnaud-de-Villeneuve, Montpellier.
Ann Chir. 1994;48(9):809-13.
Mitral valve exposure is widely improved by the superior-transseptal approach (STS). The diffusion of this technique has been restricted because of the possibility of detrimental effects of sino-atrial arrhythmias, especially in patients in sinus rhythm preoperatively. Between April 1991 and December 1992, we performed mitral valve replacement (MVR) on 55 patients by an STS approach. The mean age was 57.7 +/- 11.3 years (38-75 years). 21 were reoperations and 1 patient had been operated twice. The procedure consisted in 10 MVR with a bioprosthetic valve and 45 with a mechanical valve. Associated procedures were 5 tricuspid annuloplasties, 13 aortic valve replacements, 1 tricuspid valve replacement, 4 CABG, and 1 aneurysm resection. Overall hospital mortality was 9.1 +/- 3.8% (5/55). Mortality for isolated MVR was 6.2 +/- 4.2% (2/32). 51% (28/55) were in sinus rhythm (SR) preoperatively, 43% (12/28) of them had never presented atrial fibrillation. Postoperatively among those 28 patients in SR, 20 remained in SR, 7 were in atrial fibrillation, and 1 in atrial flutter. 3.6% (2/55) needed transient electrosystolic pacing for very slow atrial fibrillation 20% (11/55) have presented a transient sino-atrial dysfunction; None of these rhythmic events had any adverse effect. Finally, the very good visibility and accessibility are the major advantages of this approach, especially in mitro-tricuspid combined procedures, in small left atrium and repeat surgery. As sino-atrial arrhythmias are transient, we think this approach can be routinely employed in MVR.
经房间隔上入路（STS）能显著改善二尖瓣显露。但由于该技术可能引发窦房性心律失常的有害影响，其应用推广受到限制，尤其是对术前处于窦性心律的患者。1991年4月至1992年12月期间，我们采用经房间隔上入路对55例患者进行了二尖瓣置换术（MVR）。平均年龄为57.7±11.3岁（38 - 75岁）。其中21例为再次手术患者，1例接受过两次手术。手术包括10例使用生物瓣的二尖瓣置换术和45例使用机械瓣的二尖瓣置换术。相关手术包括5例三尖瓣成形术、13例主动脉瓣置换术、1例三尖瓣置换术、4例冠状动脉旁路移植术和1例动脉瘤切除术。总体住院死亡率为9.1±3.8%（5/55）。单纯二尖瓣置换术的死亡率为6.2±4.2%（2/32）。术前51%（28/55）为窦性心律（SR），其中43%（12/28）从未发生过房颤。在这28例窦性心律患者术后，20例仍为窦性心律，7例发生房颤，1例发生房扑。3.6%（2/55）因极缓慢房颤需要短暂的电收缩起搏；20%（11/55）出现过短暂的窦房功能障碍；这些节律事件均未产生任何不良影响。最后，该入路具有极佳的视野和操作便利性，这是其主要优势，尤其在二尖瓣 - 三尖瓣联合手术、左心房较小及再次手术时。由于窦房性心律失常是短暂的，我们认为该入路可常规用于二尖瓣置换术。
