经皮股静脉插管在微创主动脉瓣置换术中的应用效果

Effects of percutaneous femoral venous cannulation in minimally invasive aortic valve replacement

目的研究经皮股静脉插管在胸骨上段切口微创主动脉瓣置换术中的应用效果。方法回顾性分析中国医学科学院阜外医院心脏外科2012年5月至2017年1月的65例胸骨上段切口行主动脉瓣置换术的病例资料。根据术中静脉引流的插管方式,分为股静脉组(n=26)和右心耳组(n=39)。收集两组患者术前、术中资料及术后早期结果进行分析,对比两种插管方式的手术效果。结果两组均无住院期间死亡。股静脉组因主动脉根部出血二次开胸1例,插管局部无并发症,术后无股静脉血栓或肺栓塞发生。右心耳组术中转为常规切口1例,术后出现少量瓣周漏1例。两组均无其它重大并发症。两组间体外循环时间、阻断时间、手术时间、呼吸机使用时间、ICU停留时间、住院费用、术后住院时间、出血量、输血率等均无显著统计学差异。结论经皮穿刺股静脉插管在胸骨上段切口微创主动脉瓣置换术中的应用是安全有效的,可以替代常规的经右心耳插管,尤其在右心耳显露困难或有更高美容要求的患者更为适用。

Objective To study the effect of percutaneous femoral venous cannulation in aortic valve replacement（ AVR）through upper hemisternotomy. Methods This was a retrospective study of 65 consecutive AVR patients through upper hemisternotomy between May 2012 and January 2017 at Fuwai Hospital. The patients were divided into femoral vein group（ n = 26） and right auricle group（ n = 39）. Outcomes of the two groups were compared to study the effects of different cannulation methods. Results There was no in-hospital death in the two groups. There was a reoperation for bleeding in the femoral vein group,but no complications at the catheter site and no thrombosis in the femoral vein or pulmonary embolism happened. In the right auricle group,there was an intraoperative convertion to conventional sternotomy due to perivalvular leakage. No other severe complications were observed in both groups. There was no significant difference in cardiopulmanary bypass time,aortic cross-clamp time,operation time,mechanical ventilation time,length of ICU stay,hospitalization costs,length of postoperative hospital stay,blood loss and blood transfusion rate between the two groups.Conclusions Percutaneous femoral venous cannulation is safe and feasible in AVR through upper hemisternotomy. This method is a useful alternative to the right auricle cannulation for patients whose right auricle is difficult to expose or those who are concerned about the cosmetic result.