微创二尖瓣修复/置换已成为一种被广泛接受的治疗二尖瓣疾病的手术方法。不断的技术进步促进了这一程序的完善,提高安全性,减少手术创伤,更快的恢复时间。尽管取得了这些进步,当与其他手术结合使用时,关于微创复杂二尖瓣修复手术的数据仍然很少。
■在2008年11月至2022年12月之间,有153名患者接受了使用微创技术的手术。所有患者均接受了严重二尖瓣关闭不全/狭窄的二尖瓣手术,并至少进行了一次三尖瓣修复手术(n=52,34%)。卵圆孔未闭或房间隔缺损封堵术(n=34,22.2%),左心耳封堵术(n=25,16.3%),或电生理程序(n=101,66.0%)。98例患者(64.1%)同时进行两次手术,49例(32%)患者的三次伴随手术,6例患者(3.9%)同时进行4次手术。
■99.3%的患者(n=152)手术成功,1例患者由于收缩期前运动现象,在术后第一天需要对二尖瓣修复术进行修正.136例(88.9%)患者行二尖瓣修复术,而15例患者(9.8%)由于严重的二尖瓣狭窄,根据术前决定接受了二尖瓣置换术,和两名患者(1.3%)接受了其他二尖瓣手术。在接受额外迷宫手术的101例患者中,有86例(85.1%)在治疗房颤方面取得了成功。30天死亡率为0.7%,一名病人死于呼吸衰竭.7例患者发生神经系统并发症(4.6%)。5年随访时,再手术的自由度为98%,10年随访时为96.5%。
■微创二尖瓣手术,即使与伴随程序一起进行,作为一种可重复和安全的技术,具有出色的结果。必须向微创外科的下一个前沿迈进,鼓励有经验的外科医生使用微创方法进行更复杂的手术。这些结果有助于设想通过在合适的患者中完全通过内窥镜手段执行复杂的二尖瓣手术和相关干预来扩展微创手术的界限。
UNASSIGNED: Minimally invasive mitral valve repair/replacement has emerged as a widely accepted surgical approach for managing mitral valve disorders. Continuous technological progress has contributed to the refinement of this procedure, leading to improved safety, decreased surgical trauma, and faster recovery times. Despite these advancements, there remains a scarcity of data concerning minimally invasive complex mitral valve repair surgeries when combined with additional procedures.
UNASSIGNED: Between November 2008 and December 2022, 153 patients underwent an operation using a minimally invasive technique. All patients underwent mitral valve surgery for severe mitral valve insufficiency/stenosis in combination with at least one additional procedure for tricuspid valve repair (n = 52, 34%), patent foramen ovale or atrial septal defect closure (n = 34, 22.2%), left atrial appendage occlusion (n = 25, 16.3%), or electrophysiological procedure (n = 101, 66.0%). Two concomitant procedures were conducted in 98 patients (64.1%), three concomitant procedures in 49 patients (32%), and four concomitant procedures in 6 patients (3.9%).
UNASSIGNED: Surgical success was achieved in 99.3% of the patients (n = 152), one patient required a revision of the mitral valve repair on the first postoperative day due to systolic anterior motion phenomenon. Mitral valve repair was performed in 136 patients (88.9%), while 15 patients (9.8%) received a mitral valve replacement as per a preoperative decision due to severe mitral valve stenosis, and two patients (1.3%) underwent other mitral valve procedures. Therapeutic success in treating atrial fibrillation was achieved in 86 patients (85.1%) of the 101 who received an additional maze-procedure. The 30-day mortality rate was 0.7%, with one patient succumbing to respiratory failure. Neurological complications occurred in 7 patients (4.6%). Freedom from reoperation was calculated as 98% at 5-year follow-up and 96.5% at 10-year follow-up.
UNASSIGNED: Minimally invasive mitral valve surgery, even when performed alongside concomitant procedures, stands out as a reproducible and safe technique with outstanding outcomes. It is imperative to advance towards the next frontier in minimally invasive surgery, encouraging experienced surgeons to undertake more complex procedures using minimally invasive approaches. These results help envision extending the boundaries of minimally invasive surgery by performing complex mitral valve procedures and associated interventions entirely through endoscopic means in suitable patients.