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首页> 外文期刊>Journal of cardiac surgery. >Minimally invasive video-assisted mitral valve surgery: from Port-Access towards a totally endoscopic procedure.
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Minimally invasive video-assisted mitral valve surgery: from Port-Access towards a totally endoscopic procedure.

机译：微创视频辅助二尖瓣手术：从端口进入完全内窥镜手术。

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摘要

Right thoracotomy is an alternative to mid-sternotomy for left atrium access. The Port-Access approach is an option that reduces the skin incision and obviates rib spreading. PATIENTS AND METHODS: From February 1997 until November 1999, 121 patients underwent mitral valve surgery through a right antero-lateral thoracotomy using the Heartport cardiopulmonary bypass (CPB) system. Mean age was 60 years (31-84). Most patients had normal ejection fractions and were in NYHA Class II or III. Seventy-five patients had valve repair (62%) and 46 (38%) had valve replacement. Pathologies were myxoid (n = 80), rheumatic (n = 30), chronic endocarditis (n = 5), annular dilatation (n = 3), sclerotic (n = 1), ingrowing myxoma (n = 1), and one closure of a paravalvular leak. RESULTS: Two patients had conversion to sternotomy for aortic dissection (one died) with the Endo-Aortic Clamp, and two others for peripheral vascular problems. One patient died at postoperative day 1 after reoperation for failed repair, another with double valve surgery on postoperative day 4 after two revisions for bleeding. Twelve underwent revision for bleeding (10%). Three had prolonged ICU stay for respiratory insufficiency. Two late valve replacements for endocarditis occurred. Echographic control revealed residual insufficiencies (grade 1-2) in two valvular repairs. There were neither paravalvular leaks nor myocardial infarcts. There were no cerebrovascular accidents due to embolic phenomena. Mean ICU and hospital stay were 2.1 and 8.7 days, with a major difference between the first 30 patients and those who followed. CONCLUSION: Port-Access mitral valve surgery can be a valid alternative to conventional sternotomy and seems to be an important improvement in minimally invasive cardiac surgery.
机译：右胸廓切开术是左心房接入中胸骨切开术的替代品。端口访问方法是一种可选择切割切口并避免肋条扩展的选项。患者及方法：从1997年2月到1999年11月，121名患者通过右侧胸椎切管切开术通过右侧胸椎切开术，使用Heartport心肺旁路（CPB）系统进行右侧瓣膜术。平均年龄为60岁（31-84）。大多数患者具有正常的喷射部分，并在Nyha II类或III中。七十五名患者有阀门修复（62％）和46（38％）有阀门更换。病理学是肌瘤（n = 80），风湿性（n = 30），慢性心内膜炎（n = 5），环形扩张（n = 3），硬化（n = 1），注入肌瘤（n = 1），以及一个闭合静脉泄漏。结果：两名患者用肠道主动脉夹具的主动脉夹层（一种死亡）转化为胸骨切开术（一种死亡），以及其他两种用于外周血管问题的其他患者。一名患者在术后第1天死亡，在重新操作后重新运行后，另外一天在术后第4天进行双瓣膜手术进行两次修订后出血。十二篇接受了出血的修改（10％）。三次延长了ICU停留呼吸不足。对心内膜炎的两个晚期瓣膜置换发生。回声控制在两个阀门维修中揭示了残留的不足（1-2级）。既没有静脉曲张泄漏也没有心肌梗塞。由于栓塞现象，没有脑血管意外事故。意思是ICU和住院住宿是2.1和8.7天，前30名患者与遵循的人之间的重大区别。结论：端口接入二尖瓣手术可以是常规胸骨切开术的有效替代方案，似乎是微创心脏手术的重要改进。

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