Minimally invasive mitral valve surgery:: The subxiphoid approach
Minimally invasive mitral valve surgery:: The subxiphoid approach
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DOI：
10.1016/s0003-4975(99)00059-4
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发表时间：
1999-05-01
影响因子：
4.6
通讯作者：
Sönmez, B
中科院分区：
文献类型：
--
作者：
Karagoz, HY;Bayazit, K;Sönmez, B
背景本报告描述了二尖瓣置换术，采用独特的剑突下入路，较低的胸骨小切口和皮肤折痕切口，并比较了手术和超声心动图的结果，接受二尖瓣置换术的患者使用先前描述的策略。54例患者采用剑突下入路行二尖瓣置换术（组1）; 32例患者行二尖瓣置换术，11例患者行二尖瓣置换+三尖瓣重建术，2例患者行二尖瓣置换+三尖瓣置换术，9例患者行二尖瓣重建术。与11例行上级胸骨小切口二尖瓣置换术（第2组）和29例行胸骨正中全切口二尖瓣置换术（第3组，22例二尖瓣置换，2例二尖瓣置换+三尖瓣重建，2例二尖瓣重建，3例二尖瓣重建+三尖瓣重建）进行比较。所有组均无手术死亡。第2组患者的手术持续时间明显长于第1组和第3组患者（p < 0.01）。第1组和第2组的术后纵隔引流量显著较低（p < 0.001）。疼痛评估显示组间无差异。第1组3例患者出现心包积液。除此并发症外，三组患者术后早期超声心动图结果相似。所有患者在术后第二个月时均为纽约心脏协会心功能I级或II级，无论采用何种手术技术。胸骨小切口入路与标准正中胸骨切口入路相比无明显优势。然而，超声心动图证实剑突下入路的可靠性，任何类型的二尖瓣置换术均可采用该入路进行。(Ann Thorac Surg 1999;67：1328-33）（C）1999年，胸外科医师协会。
Background. This report describes mitral valve replacement using a unique subxiphoid approach with a lower ministernotomy and a skin crease incision and compares the operative and echocardiographic results to patients undergoing mitral valve replacements using previously described strategies.Methods. Fifty-four patients underwent mitral valve replacement using a subxiphoid approach (group 1); 32 patients underwent mitral valve replacement, 11 patients underwent mitral valve replacement + tricuspid reconstruction, 2 patients underwent mitral valve replacement + tricuspid valve replacement, and 9 patients underwent mitral reconstruction. This group of patients was compared to 11 patients who underwent mitral valve replacement through a superior ministernotomy (group 2) and 29 patients who underwent mitral valve replacement with full median sternotomy (group 3, 22 mitral valve replacements, 2 mitral valve replacements + tricuspid reconstruction, 2 mitral reconstructions, and 3 mitral reconstructions + tricuspid reconstruction).Results. There was no operative mortality in all groups. The operation lasted significantly longer in group 2 patients compared to group 1 and 3 patients (p < 0.01). Postoperative mediastinal drainage was significantly lower in groups 1 and 2 (p < 0.001). Pain assessment revealed no difference between the groups. Three patients in group 1 presented with pericardial effusion. Except for this complication, early postoperative echocardiographic findings of the patients were similar in all three groups. All patients were in New York Heart Association functional class I or II at the second postoperative month, irrespective of the surgical technique used.Conclusions. There was no prominent superiority of the ministernotomy approaches over the standard median sternotomy approach. However the reliability of the subxiphoid approach is documented echocardiographically and any type of mitral replacement can be performed with this approach. (Ann Thorac Surg 1999;67:1328-33) (C) 1999 by The Society of Thoracic Surgeons.