Two hundred forty minimally invasive mitral operations through right minithoracotomy
Two hundred forty minimally invasive mitral operations through right minithoracotomy
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DOI：
10.1016/j.athoracsur.2005.12.006
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发表时间：
2006-05-01
影响因子：
4.6
通讯作者：
Moritz, A
中科院分区：
文献类型：
--
作者：
Aybek, T;Dogan, S;Moritz, A
背景本研究报告了我们7年来使用经胸钳夹技术进行微创二尖瓣手术的经验，回顾了发病率和死亡率以及超声心动图随访结果。1997年至2004年，241例患者（121例男性;年龄56 ± 14岁）采用经胸钳夹技术通过右胸切开术接受微创二尖瓣手术。199例患者进行了重建，42个瓣膜被替换。平均切口长度为7.0 ± 1.2 cm。术前平均纽约心脏协会心功能分级为2.6 ± 0.9。30天死亡率为3.3%（n = 8）。手术、旁路和交叉夹闭时间平均分别为241 +/- 52、142 +/- 40和84 +/- 26分钟。7例患者（2.9%）转为胸骨切开术。9例患者（3.7%）因出血接受了再探查。平均重症监护室和住院时间分别为18小时和8.1天。平均随访时间为30 +/- 18个月（范围，3 - 76）。超声心动图随访证实除6例III级返流患者外，所有患者的瓣膜功能持续正常。其中5例行二尖瓣重建术，1例行二尖瓣移植术. 76个月时，无非轻微二尖瓣返流和再次手术的比率分别为92.3%和96.2%。76个月时的精算生存率（包括早期死亡率）为90.7%。所有患者胸部伤口均无感染。本研究表明，直视下经胸钳夹技术用于微创二尖瓣手术具有可重复性，死亡率和发病率较低。它具有极好的美观性，消除了胸部伤口感染的风险。其结果与常规行动的中期成果相当。
Background. This study reports of our 7- year experience with minimally invasive mitral valve operations using the transthoracic clamp technique, reviewing morbidity and mortality as well as echocardiographic follow-up results.Methods. Between 1997 and 2004, 241 patients ( 121 male; aged 56 +/- 14 years) underwent minimally invasive mitral valve surgery through right thoracotomy using the transthoracic clamp technique. Reconstructions were done in 199 patients, and 42 valves were replaced. Mean length of incision was 7.0 +/- 1.2 cm. Mean preoperative New York Heart Association functional class was 2.6 +/- 0.9.Results. Thirty- day mortality was 3.3% ( n = 8). Operating, bypass, and cross- clamp times averaged 241 +/- 52, 142 +/- 40, and 84 +/- 26 minutes, respectively. Seven patients ( 2.9%) had conversion to sternotomy. Nine patients ( 3.7%) underwent reexploration for bleeding. Mean intensive care unit and hospital stay were 18 hours and 8.1 days, respectively. Mean follow- up was 30 +/- 18 months ( range, 3 to 76). Echocardiographic follow- up documented persistently competent valve function in all but 6 patients who had grade III regurgitation. Five of them underwent mitral valve re- reconstruction and 1 underwent transplantation. At 76 months, freedom from nontrivial recurrent mitral regurgitation and reoperation were 92.3% and 96.2%, respectively. Actuarial survival at 76 months, including early mortality, was 90.7%. Thoracic wounds were free from infection in all patients.Conclusions. This study demonstrates that the direct vision, transthoracic clamp technique for minimally invasive mitral valve surgery is reproducible with low mortality and morbidity rates. It results in excellent cosmesis and abolished the risk of thoracic wound infection. Results are comparable to midterm outcomes of conventional operations.