Gulielmos V, Dangel M, Solowjowa N, Wagner F M, Karbalai P, Schmidt V, Schueler S
Cardiovascular Institute, University Hospital Dresden, Germany.
Eur J Cardiothorac Surg. 1998 Aug;14(2):141-7. doi: 10.1016/s1010-7940(98)00149-3.
Using the initial experiences with the Port-Access technique for the treatment of mitral valve disease some changes were made thus resulting in more simple and faster procedures.
Twenty-nine patients (13 male, 16 female, aged 30 to 75 years, median 62.5 +/- 11.0 years) underwent minimally invasive mitral valve surgery between May 1996 and December 1997. The underlying diseases were: mitral valve insufficiency (n = 16), mitral valve stenosis (n = 7) and combined mitral valve disease (n = 6). Through a small right thoracotomy (5-7 cm) access to the pericardium and the heart was gained. Cardiopulmonary bypass was instituted through femoral cannulation and an intraaortic balloon-catheter was introduced for aortic occlusion, aortic root venting and delivery of cold crystalloid cardioplegia. Mitral valve repair (five patients) or replacement (24 patients) was performed.
There was no death during the whole follow-up period. There was no perivalvular leak and only minor residual mitral valve regurgitation was observed on intraoperative or postoperative (3 months) transesophageal echocardiography in three patients. There was no postoperative study-related complication. Time of ventilation and intensive care unit were comparable with the data of patients undergoing conventional mitral valve surgery but hospital stay was shorter in the last 10 consecutive cases.
This simplified technique of mitral valve surgery combines the advantage of less invasive operative and good cosmetic results with the safety of conventional mitral valve surgery. At our institution this technique presents in well selected patients suffering from mitral valve disease the procedure of choice.
基于Port-Access技术治疗二尖瓣疾病的初步经验，进行了一些改进，从而使手术操作更简单、更快捷。
1996年5月至1997年12月期间，29例患者（男13例，女16例，年龄30至75岁，中位年龄62.5±11.0岁）接受了微创二尖瓣手术。基础疾病包括：二尖瓣关闭不全（n = 16）、二尖瓣狭窄（n = 7）和二尖瓣联合病变（n = 6）。通过小切口右胸壁（5 - 7cm）进入心包和心脏。通过股动静脉插管建立体外循环，并插入主动脉内球囊导管用于主动脉阻断、主动脉根部排气和冷晶体心脏停搏液的灌注。进行了二尖瓣修复（5例）或置换（24例）。
在整个随访期间无死亡病例。无瓣周漏，仅3例患者在术中或术后（3个月）经食管超声心动图检查发现轻微二尖瓣反流。无术后与研究相关的并发症。通气时间和重症监护病房时间与接受传统二尖瓣手术患者的数据相当，但在连续的最后10例病例中住院时间较短。
这种简化的二尖瓣手术技术结合了微创操作的优势和良好的美容效果以及传统二尖瓣手术的安全性。在我们机构，对于精心挑选的二尖瓣疾病患者，该技术是首选的手术方法。
