微创心脏瓣膜替换术73例报告

目的介绍一种微创心脏瓣膜替换术的新方法。方法于１９９７年３月至１９９８年４月为７３例瓣膜患者经右侧腋下胸部小切口,皮切口平均长度为（８５±０９）ｃｍ,进行了心脏瓣膜替换手术。结果平均循环阻断时间（８８６±３３８）分钟,平均转机（１１７０±４５９）分钟,有５例患者未阻断升主动脉,室颤下完成了二尖瓣替换术。术后气管插管时间（９６±３６）小时,平均胸液引流量（２６４５±１８４３）ｍｌ。１例患者院内死于脑出血。随诊中２例患者出现感染性心内膜炎,其中１例患者死亡。其他随诊良好。结论微创心脏瓣膜替换术安全可靠,可减少手术对患者的影响,利于患者恢复,同时为换瓣手术技术的改进提供了新经验。

Minimally invasive approach for heart valve replacement: report of 73 cases

OBJECTIVE: To report a new minimally invasive approach for heart valve operation. METHODS: Through right minimal vertical infra-axillary thoracotomy incision (by intercostal space), 68 patients with rheumatic heart disease, 2 patients with subacute endocarditis, and 3 patients with congenital heart disease underwent heart valve replacement from March 1997 to Spring 1998. RESULTS: 30 double valve replacements, 33 mitral valve replacements, 10 aortic valve replacements and 14 DeVega tricuspid annuloplasty were performed. The length of the incision averaged (8.5 +/- 0.9) cm, arrest times averaged (88.6 +/- 33.8) min, cardiopulmonary bypass times averaged (117.0 +/- 45.9) min. Five mitral valve replacements were performed with ventricular fibrillation. Ventilator periods averaged (9.6 +/- 3.6) h, chest tube drainage averaged (264.5 +/- 184.3) ml. One patient died of cerebral bleeding in hospital. Two patients suffered SBE and one of them died. The results of follow up for other patients were fine. CONCLUSIONS: This minimally incisive valve operation is a new safe, small wounded and cosmetic approach for heart valve replacement.