Short-term outcomes of minimally invasive mitral valve repair: a propensity-matched comparison
Short-term outcomes of minimally invasive mitral valve repair: a propensity-matched comparison
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微创二尖瓣修复术的短期结果：倾向匹配比较
DOI：
10.1093/icvts/ivx402
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发表时间：
2018-05-01
影响因子：
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通讯作者：
Wang, Zhinong
中科院分区：
文献类型：
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作者：
Wang, Qing;Xi, Wang;Wang, Zhinong
目的：探讨微创二尖瓣修补术对早期肺功能和血流动力学的影响及其近期疗效。方法：选择2012年3月至2015年7月78例二尖瓣微创修补术和89例常规二尖瓣修补术，将67例符合条件的患者分为常规开胸组和右侧小切口组(RT组)。结果：两组患者的住院病死率相似(3.0%比1.5%，P=1.000)。RT组插管时间和体外循环时间均高于常规开胸组(P<；0.001)，而常规开胸组引流量、输血量和重症监护病房住院时间均高于常规开胸组(P<；0.001)。术后0、4、8h RT组动脉血氧分压(PaO2)/吸入氧分压(FiO(2))显著低于常规开胸组(P<；0.05)，而血管外肺水指数(ELWI)、肺血管通透性指数(PVPI)和肺泡-动脉血氧分压差(PA-AO2)高于常规开胸组(P<；0.05)。两组在血流动力学(P>；0.05)、并发症发生率(P>；0.05)和短期复发率(P=0.7697)方面没有差异。结论：与胸骨正中切开入路相比，RT入路在短期疗效和安全性方面具有相似的结果。在相对增加的体外循环时间和手术时间上，RT方法缩短了患者的重症监护病房停留时间，减少了输血需求。RT手术后不久肺功能可能会受到影响，但在血流动力学方面差异不大。
OBJECTIVES: We aimed to investigate the effect of minimally invasive mitral valve repair on early pulmonary function and haemodynamics, as well as its short-term efficacy.METHODS: From March 2012 to July 2015, 78 cases of minimally invasive mitral valve repair and 89 cases of conventional mitral valve repair were included in this study, with 67 well-matched pairs of patients identified by a propensity score matching, who were divided into the conventional sternotomy group and the right minithoracotomy group (the RT group).RESULTS: The in-hospital mortality was similar between the 2 groups (3.0% vs 1.5%, P = 1.000). Both cross-clamp time and bypass time were higher in the RT group (P < 0.001), whereas drainage amount, blood transfusion and length of intensive care unit stay were higher in the conventional sternotomy group (P < 0.001). There was not much discrepancy in pulmonary function between the 2 groups, except that partial pressure of O-2 in arterial blood (PaO2)/fraction of inspired oxygen (FiO(2)) in the RT group was significantly lower than that in the conventional sternotomy group 0, 4 and 8 h after surgery (P < 0.05), whereas the extravascular lung water index (ELWI), pulmonary vascular permeability index (PVPI) and alveolar-arterial PO2 difference (PA-aO2) of the RT group was higher (P < 0.05). We found no disparity in haemodynamics (P > 0.05), incidence of complications (P > 0.05) and short-term recurrence between the 2 groups (P = 0.7697).CONCLUSIONS: When compared with the median sternotomy approach, the RT approach shows comparable results in short-term efficacy and safety. On relatively increasing cardiopulmonary bypass time and operation time, the RT approach shortens the patient's intensive care unit stay and reduces the need for blood transfusion. Pulmonary function may be affected shortly post-surgery in the RT approach, with insignificant difference in haemodynamics.