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.
■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。