Phẫu thuật tạo hình van hai lá ít xâm lấn có nội soi hỗ trợ với cải tiến kĩ thuật bộc lộ van hai lá, hướng tới phẫu thuật nội soi toàn bộ tại Trung tâm tim mạch bệnh viện E

Abstract

This was a hospital-based cohort study including 22 prospective and retrospective patients who underwent minimally invasive mitral repair between 2015 and 2017. All enrolled patients had moderate to severe mitral regurgitation and transesophageal echocardiography done preoperatively. Operative techniques included peripheral cardiopulmonary bypass establishment, a 4cm right mini-thoracotomy, a transthoracic aortic cross-clamp, and antegrade cardioplegia. Mitral valve was exposed by using a self-made pledgets and stitches hanging on the chest wall. Conventional left atrial retractor with supporting arm and rib retractor were not necessary. Almost all surgical manipulations were performed via thoracoscopic screen. The mitral valve exposure was good, 22 patients were operated on successfully. The mean age was 45.7 ± 11.8 years, 77.3% of the study population was male. The most predominant pathology was degenerative disease based on Carpentier classification, followed by functional mitral valve regurgitation Type II (77.3%), rheumatic disease Type I (18.2%). Cardiopulmonary bypass and aortic clamp times were 208.95 ± 43.68 and 143.09 ± 39.95 minutes, respectively. Repair techniques included annuloplasty 100%, leaflet resection 36%, folding 50%, neochordae implantation 14%. Overall, in-hospital and 30-day mortality were 0 %. There was no reoperation due to postoperative bleeding. The techniques were successfully applied in all patients without extending chest incision or conversion to median sternotomy. Major morbidities included 1 stroke (4.5%), 1 pleural effusion (4.5%) and 1 pericardial effusion (4.5%) requiring intervention. The ICU length of stay was 3 2 days, and average time to extubation was 18.3 8.8 hours. At 30 days after operation, an echocardiography was performed to evaluate the degree of mitral regurgitation (n = 22) which was none or trace (n=10, 45.5%), mild (n=10, 45.5%), moderate (n=2, 9%), or severe (n=0, 0%).