微创主动脉瓣置换术及术后早期结果

Minimally invasive aortic valve replacement surgery and early follow-up results

目的探讨微创主动脉瓣置换术的可行性及效果。方法回顾性分析2010年6月至2011年10月，20例单纯微创主动脉瓣置换术，男12例，女8例；平均年龄（47．60±12．28）岁。患者采用双腔气管插管，股动、静脉插管建立体外循环，右胸骨旁第3肋间切口，腋前线第4肋间置入阻断钳阻断升主动脉，完成主动脉瓣置换术。结果全组无死亡，1例因主动脉吻合口出血转为前正中开胸行升主动脉置换术，所有患者均顺利出院。19例微创主动脉瓣置换术患者平均体外循环（124．00±39．83）min，主动脉阻断（97．21±33．17）min，气管插管（13．55±3．87）h，术后ICU停留（16．34±3．82）h，术后平均住院（6．63±1．45）天。未输血患者13例。平均切口长度（4．73±0．54）em。术后复查无瓣周漏，无瓣膜功能障碍。电话或门诊随访，1例因脑梗塞死亡，余19例均恢复良好，没有瓣周漏，心功能Ⅰ级。结论采用股动、静脉插管技术建立体外循环，右胸第3肋间微小切口完成微创主动脉瓣置换术，手术创伤小，术后恢复快，出血、输血少，美容效果好，安全可靠，值得推广。

Objective The purpose of this study was to evaluate the safety and clinical outcomes of aortic valve replace- ment （AVR） performed with minimally invasive technique. Methods From June 2010 to October 2011 , 20 cases of minimal- ly invasive AVR were performed. The mean age was （47.60 ± 12. 28 ） ;12 males and 8 females. All patients are ventilated with a double-lumen endotraeheal tube, through the 3rd anterior intereostals space with a 5 -6 cm skin incision, right femoral artery and vein cannulation are used to establish CPB, direct aortic cross-clamped by Chitwood sliding clamp through the right 4th in- tercostals space, and completed the aortic valve replacement. Results Mean length of incision was （4.73 ± 0.54） cm. Mean duration of cardiopulmonary bypass was （ 124 ± 39.83） rain, erossclamp time was （97.21 ± 33.17） rain. Median intubation time was （ 13.55 ± 3.87） hours. Median duration of intensive care and postoperative hospital stay was （ 16.34 ± 3.82） hours and （6.63 ±1.45 ） days, respectively. Hospital mortality was 0. There was no perivalvular leakage. Conclusion Minimally invasive aortic replacement with a modified Port-Access approach is feasible, small incisions, more cosmetic, shorter length of hospital stay and less need for blood transfusion are attainable.