目的:部切开术和右前小切口是微创主动脉瓣置换术的2种主要技术。这项研究的目的是比较两种技术的早期和长期结果。
方法:前瞻性收集1999年至2019年期间接受孤立性微创主动脉瓣置换术的2419例患者的数据。回顾过去,患者分为小切口组(n=1352)和小切口组(n=1067).
结果:在倾向得分匹配后,每组986例患者。小开胸组的手术时间和全胸骨切开术的转换率明显高于小开胸组(184.6±45.2vs241.3±68.6,相对危险度,2.54,P=0.005和.09vs.23,相对风险,1.45,P=.013)。30天死亡率,不包括心脏死亡,小切口组低于小切口组(0.012vs0.028,相对风险,1.41,P=.011);重症监护病房住院时间(12.4vs16.5,相对风险,分别为1.62,P=0.037)和住院时间(5.4vs8.7,相对风险,分别为1.74P=.028),开胸小切口组明显更长。小切口手术方法是早期死亡率最强的独立预测因子(比值比,4.24[1.67-7.35],P=.002)。通过Kaplan-Meier分析,1、3、5、10和20年的精算生存率在小切口组明显优于小切口组(P=0.0001)。5年时无再手术的精算自由度为97.3%±4.4%,小切口组为95.8%±5.2%(P=.087)。
结论:使用小切口的微创主动脉瓣置换术与减少手术时间相关,重症监护室逗留,住院时间,术后并发症和切口疼痛,并改善早期和长期死亡率。
Ministernotomy and right anterior minithoracotomy are the 2 main techniques applied for minimally invasive aortic valve replacement. The goal of this study is to compare early and long-term outcomes of both techniques.
The data of 2419 patients undergoing isolated minimally invasive aortic valve replacement between 1999 and 2019 were prospectively collected. Retrospectively, patients were divided into the ministernotomy group (n = 1352) and the minithoracotomy group (n = 1067).
After propensity score matching, 986 patients remained in each group. Operation time and rate of conversion to full sternotomy were significantly higher in the minithoracotomy group than in the ministernotomy group (184.6 ± 45.2 vs 241.3 ± 68.6, relative risk, 2.54, P = .005 and .09 vs .23, relative risk, 1.45, P = .013, respectively). The 30-day mortality, excluding cardiac death, was lower in the ministernotomy group than in the minithoracotomy group (0.012 vs 0.028, relative risk, 1.41, P = .011, respectively); the intensive care unit length of stay (12.4 vs 16.5, relative risk, 1.62, P = .037, respectively) and hospital length of stay (5.4 vs 8.7, relative risk, 1.74 P = .028, respectively) were significantly longer in the minithoracotomy group. The minithoracotomy surgical approach was the strongest independent predictor of early mortality (odds ratio, 4.24 [1.67-7.35], P = .002). The actuarial survival by Kaplan-Meier analysis at 1, 3, 5, 10, and 20 years was significantly better in the ministernotomy group than in the minithoracotomy group (P = .0001). Actuarial freedom from reoperation at 5 years was 97.3% ± 4.4% in the ministernotomy group versus 95.8% ± 5.2% in the minithoracotomy group (P = .087).
Minimally invasive aortic valve replacement using ministernotomy is associated with reduced operative time, intensive care unit stay, hospital length of stay, and postoperative morbidities and incisional pain, and improves early and long-term mortality.