Techniques and results of direct-access minimally invasive mitral valve surgery: A paradigm for the future
Techniques and results of direct-access minimally invasive mitral valve surgery: A paradigm for the future
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DOI：
10.1016/s0022-5223(98)00448-6
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发表时间：
1998-11-01
影响因子：
6
通讯作者：
Cohn, LH
中科院分区：
文献类型：
--
作者：
Aklog, L;Adams, DH;Cohn, LH
目的：我们的目的是确定直接进入微创二尖瓣手术是否可以在保持常规手术疗效的同时提高恢复和成本。方法：106例患者行微创二尖瓣手术，其中男性占58%，平均年龄58.1岁，心室功能良好，90例行返流性黏液瘤瓣膜修复术，16例因二尖瓣过早钙化狭窄行二尖瓣成形术，采用标准器械经右侧胸骨旁切口5 ~ 8cm入路。85例患者行切开股动脉-股静脉插管，但该技术最近已被大多数患者的主动脉直接插管和经皮股静脉插管所取代。结果：无手术死亡，平均二尖瓣反流评分（0-4）由3.7降至0.7。虽然缺血和旁路手术次数增加，但术后恢复加快。呼吸支持时间、重症监护室住院时间、住院时间、康复需求和恢复“正常活动”均有所改善。医院费用、止痛药和输血也减少了。新发房颤显著增加了住院时间和费用，无深部伤口感染。其他并发症包括再次探查出血（n = 1）、短暂性脑缺血发作（n = 2）、中风（n = 1）、股动脉损伤（n = 5）、假性动脉瘤（n = 2）和升主动脉顺行夹层（n = 1）。2例死亡，1例再次手术，平均随访8.8个月。结论：直接入路微创二尖瓣手术在保持手术整体疗效的同时，可加速恢复、减少费用、减轻疼痛。它已成为我们孤立的初级二尖瓣手术的标准方法。
Objectives: Our objective was to determine whether direct-access minimally invasive mitral valve surgery can improve recovery and cost while maintaining the efficacy of conventional surgery. Methods: Minimally invasive mitral valve operations were performed on 106 patients, 58% male, average age 58.1 years, with good ventricular function, Ninety underwent repair of a regurgitant, myxomatous valve, and 16 underwent mitral valvuloplasty for prematurely calcified mitral stenosis, The valve was approached with standard instruments through a 5- to 8-cm right parasternal incision. Eighty-five had open femoral artery-femoral vein cannulation, but this technique has recently been replaced by direct cannulation of the aorta and percutaneous cannulation of the femoral vein for most patients. Results: There were no operative deaths, The mean mitral regurgitation score (0-4) decreased from 3.7 to 0.7 after the operation. Although ischemic and bypass times were increased, postoperative recovery was accelerated. Ventilatory support time, intensive care unit stay, hospital stay, need for rehabilitation, and return to "normal activities" all improved. Hospital charges, pain medications, and blood transfusions were also reduced. New atrial fibrillation contributed significantly to increased length of stay and charges, There were no deep wound infections. Other complications included re-exploration for bleeding (n = 1), transient ischemic attacks (n = 2), stroke (n = 1), femoral artery injury (n = 5), pseudoaneurysm (n = 2), and antegrade dissection of the ascending aorta (n = 1). Two patients died and 1 required reoperation during a mean follow-up of 8.8 months. Conclusions: Direct-access minimally invasive mitral valve surgery can accelerate recovery, decrease charges, and decrease pain, while maintaining overall surgical efficacy. It has become our standard approach for isolated primary mitral valve operations.