PDF(Pubmed)
Abstract：
UNASSIGNED: Minimally-invasive approaches to aortic valve replacement (MIAVR) are technically and logistically demanding. However, few centers have started using these approaches with standard equipment because of the limited resources. We sought to report intra- and postoperative clinical outcomes and address health resource utilization after MIAVR.
UNASSIGNED: A total of 102 eligible patients who had aortic valve replacement were enrolled in a prospective, multicenter cohort study conducted from June 2015 to December 2017. Fifty patients underwent aortic valve surgery via upper inverted T-shaped hemi-sternotomy (MS), and 52 patients were operated using full sternotomy (FS) in two centers in a developing country. Central cannulation was performed in all cases. Major adverse cardiac events, pain, and wound complications were compared. A cost analysis was performed, and exposure and feasibility for cannulation were assessed. The mean length of MS skin incision was 5.82 ± 0.67 cm. Cumulative cross-clamp time was insignificant between both groups (91.87 ± 34.41 versus 94.91 ± 33.96 min; p = 0.66). MS exhibited shorter ventilation time (6.18 ± 1.86 versus 10.68 ± 12.78 h; p = 0.029) and intensive care stays (33.27 ± 19.75 versus 49.42 ± 47.1 h; p = 0.037). Major adverse cardiac events (MACEs) were compared, and MS group exhibited fewer transfusions (1.18 ± 0.89 versus 1.7 ± 0.97 units; p = 0.002), fewer pulmonary complications (1 (2%) versus 2 (3.8%); p < 0.001), and less sternotomy wound infection (1 (2%) versus 5 (9.6%); p = 0.048). Total operative mortality of 4.46% was recorded (n = 5). Significant cost reduction was recorded favoring MS; central cannulation saved $907.16 and carried a total cost reduction of $580 (9.3%) when compared with the FS approach (p < 0.0001).
UNASSIGNED: With a lack of logistics in developing countries, MIAVR not only has a cosmetic advantage but carries a significant reduction in blood use, respiratory complications, pain, and cost. MIAVR can be feasible, with a rapid learning curve in developing centers.
UNASSIGNED: A total of 102 eligible patients who had aortic valve replacement were enrolled in a prospective, multicenter cohort study conducted from June 2015 to December 2017. Fifty patients underwent aortic valve surgery via upper inverted T-shaped hemi-sternotomy (MS), and 52 patients were operated using full sternotomy (FS) in two centers in a developing country. Central cannulation was performed in all cases. Major adverse cardiac events, pain, and wound complications were compared. A cost analysis was performed, and exposure and feasibility for cannulation were assessed. The mean length of MS skin incision was 5.82 ± 0.67 cm. Cumulative cross-clamp time was insignificant between both groups (91.87 ± 34.41 versus 94.91 ± 33.96 min; p = 0.66). MS exhibited shorter ventilation time (6.18 ± 1.86 versus 10.68 ± 12.78 h; p = 0.029) and intensive care stays (33.27 ± 19.75 versus 49.42 ± 47.1 h; p = 0.037). Major adverse cardiac events (MACEs) were compared, and MS group exhibited fewer transfusions (1.18 ± 0.89 versus 1.7 ± 0.97 units; p = 0.002), fewer pulmonary complications (1 (2%) versus 2 (3.8%); p < 0.001), and less sternotomy wound infection (1 (2%) versus 5 (9.6%); p = 0.048). Total operative mortality of 4.46% was recorded (n = 5). Significant cost reduction was recorded favoring MS; central cannulation saved $907.16 and carried a total cost reduction of $580 (9.3%) when compared with the FS approach (p < 0.0001).
UNASSIGNED: With a lack of logistics in developing countries, MIAVR not only has a cosmetic advantage but carries a significant reduction in blood use, respiratory complications, pain, and cost. MIAVR can be feasible, with a rapid learning curve in developing centers.
摘要：
■主动脉瓣置换术（MIAVR）的微创方法在技术上和后勤上都要求很高。然而,由于资源有限，很少有中心开始使用具有标准设备的这些方法。我们试图报告术中和术后的临床结果，并解决MIAVR后的卫生资源利用问题。
■共有102名符合条件的主动脉瓣置换术患者参加了前瞻性研究，多中心队列研究于2015年6月至2017年12月进行。50例患者通过上倒T形半胸骨切开术（MS）接受了主动脉瓣手术，52例患者在发展中国家的两个中心使用全胸骨切开术（FS）进行手术。在所有情况下进行中央插管。主要不良心脏事件，疼痛,并对伤口并发症进行比较。进行了成本分析，并评估了插管的暴露和可行性。MS皮肤切口平均长度为5.82±0.67cm。两组的累积交叉钳夹时间不显著(91.87±34.41对94.91±33.96分钟;p=0.66)。MS表现出更短的通气时间（6.18±1.86对10.68±12.78h；p=0.029）和重症监护停留时间（33.27±19.75对49.42±47.1h；p=0.037）。主要不良心脏事件（MACE）进行比较，和MS组表现出更少的输血（1.18±0.89对1.7±0.97单位；p=0.002），肺部并发症较少（1例（2%）与2例（3.8%）；p<0.001），胸骨切开术伤口感染较少（1（2％）对5（9.6％）；p=0.048）。手术总死亡率为4.46%(n=5)。记录的成本显着降低有利于MS；与FS方法相比，中央插管节省了907.16美元，总成本降低了580美元（9.3％）（p<0.0001）。
■由于发展中国家缺乏物流，MIAVR不仅具有美容优势，而且显着减少了血液使用，呼吸系统并发症,疼痛,和成本。MIAVR是可行的，在发展中中心有快速的学习曲线。
■共有102名符合条件的主动脉瓣置换术患者参加了前瞻性研究，多中心队列研究于2015年6月至2017年12月进行。50例患者通过上倒T形半胸骨切开术（MS）接受了主动脉瓣手术，52例患者在发展中国家的两个中心使用全胸骨切开术（FS）进行手术。在所有情况下进行中央插管。主要不良心脏事件，疼痛,并对伤口并发症进行比较。进行了成本分析，并评估了插管的暴露和可行性。MS皮肤切口平均长度为5.82±0.67cm。两组的累积交叉钳夹时间不显著(91.87±34.41对94.91±33.96分钟;p=0.66)。MS表现出更短的通气时间（6.18±1.86对10.68±12.78h；p=0.029）和重症监护停留时间（33.27±19.75对49.42±47.1h；p=0.037）。主要不良心脏事件（MACE）进行比较，和MS组表现出更少的输血（1.18±0.89对1.7±0.97单位；p=0.002），肺部并发症较少（1例（2%）与2例（3.8%）；p<0.001），胸骨切开术伤口感染较少（1（2％）对5（9.6％）；p=0.048）。手术总死亡率为4.46%(n=5)。记录的成本显着降低有利于MS；与FS方法相比，中央插管节省了907.16美元，总成本降低了580美元（9.3％）（p<0.0001）。
■由于发展中国家缺乏物流，MIAVR不仅具有美容优势，而且显着减少了血液使用，呼吸系统并发症,疼痛,和成本。MIAVR是可行的，在发展中中心有快速的学习曲线。
