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【 J Thorac Cardiovasc Surg】微创二尖瓣修复术的早期
Volume 137, Issue 1, January 2009, Pages 60-64
Early and late outcomes in minimally invasive mitral valve repair: An eleven-year experience in 707 patients
Objective
This study analyzes a single institution experience with minimally invasive mitral valve repair and evaluates long-term surgical outcomes of morbidity, mortality, and rates of reoperation. Late follow-up of mitral regurgitation and left ventricular function were also assessed.
Methods
Between August 1996 and October 2007, minimally invasive mitral valve repair was performed in 713 patients (mean follow-up 5.7 years). Excluding 6 repairs with robotic assistance, an perspective analysis of the remaining 707 patients was carried forth. Mean age was 57 ± 13 years. Mean preoperative ejection fraction was 60% ± 10%. Surgical access was through a lower ministernotomy (74%), right parasternal incision (24%), right thoracotomy (1.4%), or upper ministernotomy (0.7%). Exposure of the mitral valve was through the left atrium in 58% of the cases and transeptal in 42%. A ring annuloplasty was incorporated into 680 (96%) of 707 repairs. The Kaplan–Meier and Student t test for paired samples were used for statistical analysis.
Results
There were 3 (0.4%) operative deaths. Perioperative morbidity included new-onset atrial fibrillation (20%), reoperation for bleeding (2%), stroke (1.9%), permanent pacemaker implantation (1.7%), deep sternal wound infection (0.7%), and aortic dissection (0.4%). Median hospital stay was 5 days. Only 31% of patients required blood transfusion during the hospital course. There were 49 (6.9%) late deaths and 34 (4.8%) failed repairs necessitating reoperation. At 11.2 years, survival was 83% (95% confidence intervals, 76.5–88.1); freedom from reoperation was 92% (95% confidence intervals, 86.2–94.9). Nine (1.3%) patients were lost to follow-up. A total of 2369 patient-years of echocardiography time were obtained in 544 patients (mean 4.36 years, range 0.47–11.09). Mean grade of mitral regurgitation decreased from 3.80 to 1.42 (P < .0001) Mean left ventricular ejection fraction decreased from 60.7% to 56.3% (P < .0001). Combined risk of death, reoperation, and recurrence of moderately severe to severe
mitral regurgitation was 7.7% (43/555).
Conclusion
Minimally invasive mitral valve repair is safe, with low perioperative morbidity, low rates of recurrent mitral regurgitation, and low rates of reoperation and death at late follow-up. Early and late outcomes in minimally invasive mitral valve repair: An eleven-year experience in 707 patients
微创二尖瓣修复术的早期和晚期预后：707个病人11年的经验
Objective
This study analyzes a single institution experience with minimally invasive mitral valve repair and evaluates long-term surgical outcomes of morbidity, mortality, and rates of reoperation. Late follow-up of mitral regurgitation and left ventricular function were also assessed.
目的：本研究分析了单中心的在二尖瓣微创修复中的经验，并评价了并发症、病死率和二次手术率等方面的长期的外科转归。二尖瓣晚期返流情况和左心室功能也被评价。
Methods
Between August 1996 and October 2007, minimally invasive mitral valve repair was performed in 713 patients (mean follow-up 5.7 years). Excluding 6 repairs with robotic assistance, an perspective analysis of the remaining 707 patients was carried forth. Mean age was 57 ± 13 years. Mean preoperative ejection fraction was 60% ± 10%. Surgical access was through a lower ministernotomy (74%), right parasternal incision (24%), right thoracotomy (1.4%), or upper ministernotomy (0.7%). Exposure of the mitral valve was through the left atrium in 58% of the cases and transeptal in 42%. A ring annuloplasty was incorporated into 680 (96%) of 707 repairs. The Kaplan–Meier and Student t test for paired samples were used for statistical analysis.
方法：在1996年至2007年间，713名病人接受了二尖瓣微创修复术（平均随访5.7年）。6名使用机器辅助进行的手术被排除，剩下的707名病人被进行了前瞻性分析。平均年龄57± 13岁。平均术前射血分数是60%± 10%。手术入路为低位小切口（74%）、右胸骨旁切口（24%）、右胸廓切口（24%）或高位小切口（0.7%）。58%的病人通过左心房暴露二尖瓣，42%的病人越隔[标签:content1][标签:content2]
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作者:admin@医学,生命科学 2011-04-25 17:16
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