左右心房联合切口行复杂型二尖瓣手术的有效性及安全性

Effectiveness and safety of superior septal approach for complex mitral valve surgery

目的 探讨左右心房联合切口入路在复杂型二尖瓣手术中的有效性及安全性。方法 回顾性分析2011年8月至2014年11月于首都医科大学附属北京安贞医院接受二尖瓣手术治疗的86例患者的病历资料，经左右心房联合入路实施二尖瓣手术的43例作为观察组，经房间隔入路实施二尖瓣手术的43例作为对照组。比较2组患者手术情况、手术效果及并发症。结果 2组患者均顺利完成手术，无二次转机。观察组同期行主动脉瓣替换术15例，三尖瓣成形术10例，冠状动脉旁路移植术5例，主动脉根部替换术1例；对照组同期行主动脉瓣替换术15例，三尖瓣成形术19例，冠状动脉旁路移植术3例，主动脉根部替换术1例。观察组的手术时间、体外循环时间、主动脉阻断时间分别为（266±67）min、（135±46）min、（101±38）min；对照组分别为（243±63）min、（110±34）min、（76±29）min；2组间差异均无统计学意义（P〉0.05）。观察组术前窦性心律25例，术后4例转为结性心律，其中3例应用临时起搏器；术前心房颤动17例，术后6例转为窦性心律。对照组术前窦性心律13例，术后4例转为心房颤动；术前心房颤动29例，术后10例转为窦性心律。2组患者术后24 h引流量及主要并发症发生率之间差异无统计学意义（P〉0.05）。结论 经左右心房联合切口入路行复杂型二尖瓣手术是安全有效的，它能够提供良好的手术视野，保证复杂型二尖瓣手术的安全性。

Objective To explore the effectiveness and safety of complex mitral valve surgery via superior septal approach. Methods Totally 86 adult patients who had mitral valve surgery from August 2011 to November 2014 in Beijing Anzhen Hospital, Capital Medical University were retrospectively analyzed; 43 patients were operated via superior septal approach（SSA group）; 43 patients had interatrial septal approach（ISA group）. Operation data, operative effects and complications were analyzed. Results All patients were successfully operated; no re-cardiopulmonary bypass（CPB） was required. The SSA group had concomitant operations including aortic valve replacement（n=15）, tricuspid valve plasty（n=10）, coronary artery bypass grafting（n=5） and Bentall operation（n=1）; the ISA group had aortic valve replacement（n=15）, tricuspid valve plasty（n=19）, coronary artery bypass grafting（n=3） and Bentall operation（n=1）. The operation time, CPB time, aortic cross-clamp time in SSA and ISA group were （266±67）min vs （243±63）min, （135±46）min vs （110±34）min, （101±38）min vs （76±29）min, respectively; there were no significant differences between groups（P〉0.05）. The SSA group had 25 cases of sinus rhythm（SR） before operation; 4 cases had nodal rhythm after operation, among them 3 cases were applied temporary pacemaker; 6 in 17 cases of preoperative atrial fibrillation（AF） regained SR. In ISA group, 4 in 13 patients with preoperative SR had AF; 10 in 29 patients with preoperative AF regained SR. Postoperative 24 h drainage volume and 24 h incidence of complications had no significant differences between groups（P〉0.05）. Conclusion Mitral valve surgery via superior septal approach is feasible and effective; it provides better operative field and eusures the safety of operation.