Letsou G V, Reardon M J
Baylor College of Medicine, Department of Surgery, Houston, TX 77030, USA.
Curr Opin Cardiol. 1998 Mar;13(2):105-10. doi: 10.1097/00001573-199803000-00006.
Minimally invasive surgical techniques have proliferated at a staggering rate in the last decade. Cardiac surgery has been a late entrant in this process but is currently experiencing a surge of interest in and techniques for minimally invasive approaches. Cardiac valve surgery has seen a rapid and ongoing evolution of minimally invasive approaches that, it is hoped, will decrease patient discomfort, operative morbidity, length of hospitalization, and cost, improve cosmetic healing, and facilitate return to normal function while not compromising short- or long-term outcomes of the surgical procedure. This article examines the evolution of recent experience with minimally invasive valve surgery and emphasizes the surgical considerations surrounding 1) the choice of incision, 2) access techniques for cardiopulmonary bypass (CPB), 3) methods of myocardial protection, 4) techniques for aortic occlusion, and 5) atrial incisions for exposure of the mitral valve. The results of early and currently available series are also reviewed.
在过去十年中，微创外科技术以惊人的速度迅速发展。心脏外科在这一进程中起步较晚，但目前对微创方法的兴趣和技术正经历激增。心脏瓣膜手术的微创方法已迅速且持续发展，人们希望这些方法能减少患者不适、手术发病率、住院时间和成本，改善美容效果，促进恢复正常功能，同时不影响手术的短期或长期效果。本文探讨了微创瓣膜手术近期经验的演变，并强调了围绕以下方面的手术考量：1）切口选择；2）体外循环（CPB）的通路技术；3）心肌保护方法；4）主动脉阻断技术；5）用于暴露二尖瓣的心房切口。还回顾了早期和现有系列研究的结果。
