Evolution of mitral valve surgery: Toward a totally endoscopic approach
Evolution of mitral valve surgery: Toward a totally endoscopic approach
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DOI：
10.1016/s0003-4975(01)02978-2
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发表时间：
2001-10-01
影响因子：
4.6
通讯作者：
Holbert, D
中科院分区：
文献类型：
--
作者：
Felger, JE;Chitwood, R;Holbert, D
背景我们的研究评估了一系列的视频辅助微创二尖瓣手术，显示了向全内窥镜技术的安全进展。患有孤立性二尖瓣疾病的连续性患者接受手动指导（n = 55）或语音激活机器人指导（n = 72）视频辅助二尖瓣手术。冷血心脏停搏液，经胸主动脉钳，5毫米内窥镜和5厘米。采用小切口开胸。将该视频辅助微创二尖瓣手术队列与先前基于胸骨切开术的二尖瓣手术队列（n = 100）进行比较。两组的人口统计学资料、纽约心脏协会分级和心功能相似。在61.8%的手动引导（n = 34）、75.0%的机器人引导（n = 54）和54%的基于胸骨切开术（N = 54）的二尖瓣手术中进行了修复。与基于胸骨切开术的技术相比，机器人引导技术显示失血量、呼吸机时间和住院时间显著减少。与机器人引导的二尖瓣手术相比，手动引导的二尖瓣手术的停搏时间缩短（128.0 +/- 4.5分钟与90.0 +/- 4.6分钟; p < 0.001），灌注时间缩短（173.0 +/- 5.7分钟与144.0 +/- 4.6分钟; p < 0.001）。在微创二尖瓣手术队列中，并发症包括再探查出血（2.4%; n = 3）和1例卒中（0.8%），而30天死亡率为2.3%（n = 3）。与传统胸骨入路相比，视频辅助二尖瓣手术提供了安全有效的结果。这些积极的结果表明，完全内窥镜二尖瓣手术是安全和逐步发展的。(C)2001年由胸外科医师协会出版。
Background. Our study evaluates a series of video-assisted minimally invasive mitral operations, showing safe progression toward totally endoscopic techniques.Methods. Consecutive patients with isolated mitral valve disease underwent either manually directed (n = 55) or voice-activated robotically directed (n = 72) video-assisted mitral operations. Cold blood cardioplegia, a transthoracic aortic clamp, a 5-mm endoscope, and a 5-cm. minithoracotomy were used. This video-assisted minimally invasive mitral operation cohort was compared with a previous sternotomy-based mitral operation cohort (n = 100).Results. Group demographics, New York Heart Association classification, and cardiac function were similar. Repairs were performed in 61.8% manually directed (n = 34), 75.0% robotically directed (n = 54), and 54% sternotomy-based (N = 54) mitral operations. The robotically directed technique showed a significant decrease in blood loss, ventilator time, and hospitalization compared with the sternotomy-based technique. Manually directed mitral operations compared with robotically directed mitral operations had decreased arrest times (128.0 +/- 4.5 minutes compared with 90.0 +/- 4.6 minutes; p < 0.001) and decreased perfusion times (173.0 +/- 5.7 minutes compared with 144.0 +/- 4.6 minutes; p < 0.001). In the minimally invasive mitral operation cohort, complications included reexploration for bleeding (2.4%; n = 3) and one stroke (0.8%), whereas the 30-day mortality was 2.3% (n = 3).Conclusions. Video-assisted mitral surgery provides safe and effective results when compared with conventional sternal approaches. These positive results show a safe and stepwise evolution toward a totally endoscopic mitral valve operation. (C) 2001 by The Society of Thoracic Surgeons.