全胸腔镜微创主动脉瓣及双瓣置换术的早期结果

Eearly outcomes of totally thoracoscopic minimally invasive aortic valve and double valve replacement

目的总结全胸腔镜微创主动脉瓣置换(aortic valve replacement,AVR)及双瓣置换(double valve replacement,DVR)的早期结果。方法回顾性分析2020年4月—2021年1月于广东省人民医院全胸腔镜下行AVR和DVR患者的临床资料。根据手术方式将患者分为AVR组和DVR组,比较两组患者临床资料。结果纳入患者22例,其中男14例、女8例,平均年龄(50.0±11.2)岁。退行性病变8例,风湿性心脏病联合瓣膜病8例,二叶式主动脉瓣6例。AVR组16例,DVR组6例。所有患者均顺利完成手术,无死亡病例,术中出现瓣周漏2例。体外循环和主动脉阻断时间分别为(187.0±39.9)min和117.0(99.0,158.0)min,术后机械通气和ICU停留时间分别为9.5(4.8,18.3)h和41.0(34.0,64.0)h,术后24 h胸腔引流量(214.0±124.6)mL,术后住院时间5.5(4.0,8.3)d。DVR组体外循环时间、主动脉阻断时间比AVR组长,术后24 h胸腔引流量比AVR组多,且差异具有统计学意义(P<0.05)。平均随访时间(5.9±3.0)个月,无死亡病例。结论全胸腔镜下微创AVR及DVR早期结果满意,是一种值得探讨的手术方式。

Objective To summarize the early outcomes of totally thoracoscopic minimally invasive aortic valve replacement(AVR)and double valve replacement(DVR).Methods The clinical data of patients who underwent totally thoracoscopic minimally invasive AVR or DVR in Guangdong Provincial People’s Hospital from April 2020 to January 2021 were retrospectively analyzed.The patients were divided into an AVR group and a DVR group according to the surgical method,and the clinical data of the two groups were compared.Results Finally 22 patients were enrolled,including 14 males and 8 females with an average age of 50.0±11.2 years at operation.Eight patients were degenerative disease,8 were rheumatic heart disease combined with valvular disease,and 6 were bicuspid aortic valve.Out of the 22 patients,16 underwent AVR alone,and 6 underwent DVR.All patients completed the operation successfully,and there was no death.Perivalvular leakage during surgery occurred in 2 patients.The average cardiopulmonary bypass time was 187.0±39.9 minutes,and aortic cross-clamping time was 117.0(99.0,158.0)minutes.Duration of mechanical ventilation and intensive care unit stay was 9.5(4.8,18.3)hours and 41.0(34.0,64.0)hours,respectively.The volume of chest drainage at the first 24 hours after surgery was 214.0±124.6 mL,and the postoperative hospital stay was 5.5(4.0,8.3)days.The cardiopulmonary bypass time and aortic cross-clamping time in the DVR group were longer than those in the AVR group,and the volume of chest drainage at 24 hours after surgery was more than that in the AVR group,with a statistical difference(P<0.05).Echocardiography before hospital discharge showed paravalvular leakage in 1 patient.There was no death during follow-up of 5.9±3.0 months.Conclusion The early outcome of totally thoracoscopic minimally invasive AVR and DVR is satisfactory,and the approach of surgery is worth exploring.