Glower D D, Landolfo K P, Clements F, Debruijn N P, Stafford-Smith M, Smith P K, Duhaylongsod F
Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
Eur J Cardiothorac Surg. 1998 Oct;14 Suppl 1:S143-7. doi: 10.1016/s1010-7940(98)00123-7.
The advantages and disadvantages of minimally invasive Port Access mitral valve operation have not been defined relative to standard median sternotomy. A study was therefore designed to delineate differences in outcome from mitral operation via Port Access versus sternotomy in comparable patients.
The records of 41 consecutive patients undergoing isolated mitral valve replacement (n = 14) or repair (n = 27) were examined. All operations were performed using cardioplegic arrest through either median sternotomy (n = 20) or a small right anterolateral thoracotomy using an endoaortic clamp and catheter system (Heartport, Redwood City, CA) to arrest and decompress the heart (Port Access, n = 21).
Both groups were well matched for age, mitral pathology, ejection fraction, and comorbidity. except that Port Access patients were less likely to be female. Three patients had undergone previous cardiac operations. Surgical procedure time was longer for Port Access patients (384+/-80 vs. 263+/-41 min, P < 0.05). Port Access provided significantly smaller incision length (8+/-2 vs. 26+/-2 cm, P < 0.01) and similar or shorter hospital stay (6+/-4 vs. 7+/-3 days). Port Access provided excellent visualization of the mitral valve and subvalvular apparatus, generally better than sternotomy, to allow complex mitral valve repairs. The greatest advantage of Port Access mitral operation was that Port Access patients returned to normal activity more rapidly (4+/-2 vs. 9+/-1 weeks, P = 0.01) than did patients undergoing standard median sternotomy.
By avoiding a sternotomy, Port Access mitral valve operation provided a smaller incision and a dramatically more rapid return to normal activity than did median sternotomy. Port Access cardioplegic arrest with the Heartport system allowed visualization of the mitral valve superior to median sternotomy and has become the standard approach at this institution.
与标准正中开胸手术相比，微创端口入路二尖瓣手术的优缺点尚未明确。因此设计了一项研究，以描绘在可比患者中经端口入路与开胸进行二尖瓣手术的结果差异。
检查了41例连续接受单纯二尖瓣置换术（n = 14）或修复术（n = 27）患者的记录。所有手术均通过正中开胸（n = 20）或使用主动脉内阻断钳和导管系统（Heartport，加利福尼亚州红木城）的小右前外侧开胸进行心脏停搏和减压（端口入路，n = 21）。
两组在年龄、二尖瓣病变、射血分数和合并症方面匹配良好，只是端口入路组女性较少。3例患者曾接受过心脏手术。端口入路组患者的手术时间更长（384±80 vs. 263±41分钟，P < 0.05）。端口入路的切口长度明显更小（8±2 vs. 26±2厘米，P < 0.01），住院时间相似或更短（6±4 vs. 7±3天）。端口入路能很好地显露二尖瓣和瓣下结构，总体上优于开胸手术，从而能进行复杂的二尖瓣修复。端口入路二尖瓣手术最大的优势在于，与接受标准正中开胸手术的患者相比，端口入路组患者恢复正常活动的速度更快（4±2 vs. 9±1周，P = 0.01）。
通过避免正中开胸，端口入路二尖瓣手术与正中开胸相比切口更小，恢复正常活动的速度明显更快。使用Heartport系统进行端口入路心脏停搏能提供比正中开胸更好的二尖瓣视野，已成为本机构的标准术式。
