全胸腔镜再次二尖瓣置换术的临床疗效及生存分析

Clinical efficacy and survival analysis of totally thoracoscopic redo mitral valve replacement

目的分析全胸腔镜再次二尖瓣置换术的临床疗效及生存结局,评估其有效性与安全性。方法回顾性分析2013—2019年于广东省人民医院行全胸腔镜再次二尖瓣置换术患者的临床资料。采用Kaplan-Meier法进行生存分析并绘制曲线。采用单因素、多因素Cox回归分析术后死亡的危险因素。结果共纳入48例患者,其中男19例、女29例,中位年龄53(44,66)岁。全组均顺利完成手术,无中转正中开胸。分别有15例、10例、23例患者在体外循环停跳下、不停跳下、心室颤动下完成手术。全组住院死亡率为6.25%(3/48),术后早期并发症发生率为18.75%(9/48)。35例(72.92%)患者于术后24 h内拔除气管插管。术后1年和6年生存率分别为89.50%[95%CI(81.30%,98.70%)]和82.90%[95%CI(71.50%,96.20%)]。年龄>65岁为术后死亡的独立危险因素(P=0.04)。结论全胸腔镜再次二尖瓣置换术安全可靠,在快速康复、降低输血率、减少术后并发症等方面有优势,远期生存率高,值得临床推广。

Objective To analyze the clinical efficacy and survival outcome of totally thoracoscopic redo mitral valve replacement and evaluate its efficiency and safety.Methods The clinical data of patients with totally thoracoscopic redo mitral valve replacement in Guangdong Provincial People’s Hospital between 2013 and 2019 were retrospectively analyzed.Survival analysis was performed using the Kaplan-Meier method.Univariate and multivariate Cox regression analyses were used to determine the risk factors for postoperative death.Results There were 48 patients including 29 females and 19 males with a median age of 53(44,66)years.All the procedures were performed successfully with no conversion to median sternotomy.A total of 15,10 and 23 patients received surgeries under non-beating heart,beating heart and ventricular fibrillation,respectively.The in-hospital mortality rate was 6.25%(3/48),and the incidence of early postoperative complications was 18.75%(9/48).Thirty-five(72.92%)patients had their tracheal intubation removed within 24 hours after the operation.The 1-and 6-year survival rates were 89.50%(95%CI 81.30%-98.70%)and 82.90%(95%CI 71.50%-96.20%),respectively.Age>65 years was an independent risk factor for postoperative death(P=0.04).Conclusion Totally thoracoscopic redo mitral valve replacement is safe and reliable,with advantages of rapid recovery,reducing blood transfusion rate,reducing postoperative complications and acceptable long-term survival rate.It is worthy of being widely popularized in the clinic.