Utley J R, Leyland S A, Nguyenduy T
Division of Cardiac Surgery, Spartanburg Regional Medical Center, S.C.
J Thorac Cardiovasc Surg. 1995 Mar;109(3):582-7. doi: 10.1016/S0022-5223(95)70292-X.
We compared the preoperative status, operative factors, and postoperative outcomes among patients having mitral valve operations with three atrial incisions. The incisions were right lateral (n = 66), superior septal (n = 46), and transseptal (n = 37). Differences in patient and operative factors among the groups were not predictors of adverse postoperative outcomes with multiple regression analysis. Postoperative pulmonary failure was less common in the superior septal group. Patients in the superior septal group more commonly required permanent pacemakers than those in the right lateral group. In patients with sinus rhythm before operation, sinus rhythm had returned before hospital discharge more commonly in those in the right lateral group (35 of 44, 80%) than in those in the superior septal group (18 of 28, 46%) or in the transseptal group (9 of 13, 69%). With multiple regression analysis the type of atrial incision was not a predictor of postoperative pulmonary failure or need for permanent pacemaker. Right lateral and transseptal atrial incisions were predictors of retention of sinus rhythm after operation. We conclude that the results of superior septal incision are comparable with those of other incisions except for a slightly greater risk of loss of sinus rhythm. One must weigh the technical advantages of the superior septal incision against the risk of loss of sinus rhythm.
我们比较了接受三种心房切口二尖瓣手术患者的术前状况、手术因素和术后结果。切口分别为右外侧切口（n = 66）、上间隔切口（n = 46）和经房间隔切口（n = 37）。通过多元回归分析，各组患者和手术因素的差异并非术后不良结果的预测因素。上间隔组术后肺功能衰竭较少见。上间隔组患者比右外侧组患者更常需要永久性起搏器。术前为窦性心律的患者中，右外侧组（44例中的35例，80%）出院前窦性心律恢复的比例高于上间隔组（28例中的18例，46%）或经房间隔组（13例中的9例，69%）。通过多元回归分析，心房切口类型并非术后肺功能衰竭或需要永久性起搏器的预测因素。右外侧和经房间隔心房切口是术后窦性心律保留的预测因素。我们得出结论，除窦性心律丧失风险略高外，上间隔切口的结果与其他切口相当。必须权衡上间隔切口的技术优势与窦性心律丧失的风险。
