12例右胸骨旁第3肋间小切口行三瓣膜手术的临床经验

Experience of three valve surgery with minimally invasive right-parasternal-approach in 12 patients

目的 总结我院经右胸骨旁第3肋间小切口行三瓣膜手术的临床经验。方法 2013年6月至2014年3月12例患者接受手术治疗,其中男性8例,女性4例;年龄35~65岁,平均（48.3±9.1）岁。患者中包括：9例风湿性瓣膜病,累及二尖瓣及主动脉瓣,合并有继发性三尖瓣关闭不全;1例风湿性瓣膜病,累及二尖瓣、主动脉瓣及三尖瓣;2例主动脉瓣退行性病变致继发性二尖瓣、三尖瓣关闭不全。12例患者均在全身麻醉、双腔气管插管、体外循环辅助下手术,术式包括二尖瓣、主动脉瓣及三尖瓣置换术1例,二尖瓣、主动脉瓣置换及三尖瓣成形术9例,主动脉瓣置换、二尖瓣及三尖瓣成形术2例。结果 无围术期死亡,无中转开胸手术,无再次开胸止血。6例患者输血,平均输血量为（408.3±444.4）mL。无主动脉夹层、肾功能不全及感染等并发症。术后随访3~9个月,平均（6.3±2.0）个月,无瓣周漏及严重心血管事件发生。结论 经右胸骨旁第3肋间小切口行微创三瓣膜手术安全有效,可减少手术创伤,增加患者满意度,作为临床治疗的一种选择。

Objective To sum up the experience of three valve surgery with minimally invasive rightparasternal-approach. Methods From Jun.2013 to Mar.2014,12 patients were treated with this approach,which including 8males and 4females.The mean age was（48.3±9.1）years old,ranging from 35 to 65years old.The etiology was including of rheumatic and degenerative valve disease.All 12 patients were under general anesthesia,double-lumen endotracheal intubation and cardiopulmonary bypass.1patient went for mitral valve,aortic valve and tricuspid valve replacement.Nine patients went for mitral valve,aortic valve replacement and tricuspid valve repair.The other 1patient went for aortic valve replacement and mitral valve,tricuspid valve repair. Results There was no perioperational death,no conversion for full sternotomy and no resternotomy for bleeding.Six patients need blood transfusion of（408.3±444.4）mL on the average.No complication like aortic dissection,renal failure or infection happened.Follow-up observation showed no perivalvular leakage and cardiocerebral event occurred in average（6.3±2.0）months. Conclusions Three valve surgery with minimally invasive right-parasternal-approach is safe and feasible with less operation wound and more satisfaction for patients.It is one choice of clinical practice.