右侧胸骨旁纵行小切口入路在微创主动脉瓣置换术中的应用研究

Application of right parasternal longitudinal small incision approach to minimally invasive aortic valve replacement

目的目的总结右侧胸骨旁纵行小切口入路行微创主动脉瓣置换术的临床经验,并评价其安全性及疗效。方法回顾性分析8例接受右侧胸骨旁纵行小切口入路微创主动脉瓣置换术患者的临床资料(微创组),并与同期22例采用常规经前正中切口入路手术患者的临床资料(传统组)进行比较,观察两组患者相关手术指标,包括手术时间、切口长度、体外循环时间、主动脉阻断时间、术后24 h胸腔引流量、引流管留置时间等。微创组术后通过门诊随访,随访截止时间2018年7月,记录心功能恢复及死亡情况。结果两组患者手术均成功完成,无死亡病例,均痊愈出院。微创组手术切口长度明显短于传统组,体外循环时间、主动脉阻断时间长于传统组,术中出血量、输血量、输血率、术后24 h胸腔引流量、引流管留置时间、术后呼吸机辅助时间、术后ICU停留时间、术后住院时间均少于/短于传统组(均P<0.05)。两组手术时间比较,差异无统计学意义(P>0.05)。两组并发症发生率比较,差异无统计学意义(P>0.05)。微创组术后左心室舒张末期内径(LVEDD)、升主动脉直径(AAD)均明显小于术前(P<0.05)。微创组随访(37.45±6.58)个月,无死亡病例,心功能恢复至Ⅰ级,人工瓣膜未见异常。结论右侧胸骨旁纵行小切口入路之微创主动脉瓣置换术创伤小,出血和输血少,并发症相对少,术后恢复快,安全可靠,效果确切。

Objective To summarize the clinical experience of right parasternal longitudinal small incision applied to minimally invasive aortic valve replacement (AVR), and to evaluate its safety and efficacy. Methods The clinical data of 8 patients undergoing minimally invasive AVR through right parasternal longitudinal small incision(minimally invasive group) were retrospectively analyzed, and were compared with those of 22 concurrent patients undergoing conventional procedure through anterior median incision (conventional group). Relevant surgical indices were compared between the two groups, including operation duration, length of incision, duration of cardiopulmonary bypass, duration of aortic occlusion, thoracic drainage at 24h after operation, indwelling time of drainage tube, et al. The minimally invasive group accepted outpatient follow-up by a deadline of July 2018, and their cardiac function recovery and mortality were recorded. Results The operation was performed successfully in both groups, no cases died, all patients were cured and discharged. Compared with the conventional group, the minimally invasive group had notably shorter incision, longer durations of cardiopulmonary bypass and aortic occlusion, less intraoperative blood loss, blood transfusion, blood transfusion rate, and thoracic drainage at 24h after operation, as well as shorter indwelling time of drainage tube, duration of postoperative mechanical ventilation, postoperative ICU stay, and postoperative hospital stay (all P <0.05). There was no statistically significant difference in operation duration or incidence rate of complications between the two groups (all P >0.05 ). In the minimally invasive group, left ventricular end diastolic dimension(LVEDD), ascending aorta diameter(AAD) after operation were significantly smaller than those before operation ( P <0.05).All patients in the minimally invasive group were followed up for 37.45±6.58 months, no cases died, with the heart function restored to gradeⅠ, and no prosthetic valve dysfunction was found. Conclusion Right parasternal longitudinal small incision applied to minimally invasive AVR achieves a definite efficacy, with minor trauma, less blood loss and blood transfusion, relatively fewer complications and faster postoperative recovery, and it is safe and reliable.