关键词:

微创心脏外科, 右胸微创切口, 胸骨上段切口, 心脏瓣膜假体植入

Abstract:

Objective To explore the short⁃term clinical effect of the two approaches：right mini⁃thoracot⁃ omy（RMT）and partial upper sternotomy（PUS）in aortic valve replacement（AVR）comparatively. Methods A total of 240 patients who underwent aortic valve replacement with RMT（n = 120）and PUS（n = 120）from August 2017 to June 2021 in Union Hospital were enrolled in the retrospective analysis. The preoperative history，general situation of operation，postoperative complications and follow ⁃ up results were compared between the two groups. Results The preoperative baseline characteristics of the two groups were comparable，and all valvular surgeries were completed successfully and effectively. The cardiopulmonary bypass time（P = 0.02）and aortic cross⁃clamping time（P = 0.03）in the RMT group were longer than those in the PUS group，but the total value of blood transfusion was significantly smaller（P = 0.02），the ICU stay and postoperative hospitalization were both significantly shorter （P = 0.02，P = 0.04），and the rate of postoperative complications was significantly smaller than those in PUS group. The short⁃term follow⁃up showed no significant difference in the survival rate and the rate of major complications between the two groups（P > 0.05）. Conclusion Aortic valve replacement through RMT is safe and feasible，which can be combined with video⁃assisted thoracoscopy. Compared with PUS，RMT has the advantages of less trauma，rapider recovery，shorter postoperative hospital stay and better cosmetic results. The short⁃term effect of RMT is exactly the same as that of PUS，thus it is expected to become a routine choice for some patients undergoing aortic valve replacement in case of no contraindications.

Key words:

minimally invasive cardiac surgery, right mini ?thoracotomy, partial upper sternotomy, heart valve prosthesis implantation