Ministernotomy: A preliminary experience in heart valve surgery

Pavle Kovacevic, Bogoljub Mihajlovic, Lazar Velicki, Aleksandar Redzek, Vladimir Ivanovic, Nikola Komazec
2011 Vojnosanitetski Pregled  
Institut za kardiovaskularne bolesti Vojvodine, *Klinika za kardiovaskularnu hirurgiju, † Klinika za kardiologiju, Sremska Kamenica, Srbija Apstrakt Uvod/Cilj. Poslednja decenija 20. veka donela je značajan napredak u razvoju mini invazivnih pristupa u hirurgiji srčanih valvula. Potencijalne prednosti ovih pristupa uključuju dobar estetski aspekt, smanjenu bolnost, redukciju krvarenja i mogućnosti infekcije, kraći boravak u jedinici intenzivne nege i kraću hospitalizaciju. Parcijalna gornja
more » ... rcijalna gornja sternotomija je trenutno metoda izbora za minimalno invazivnu hirurgiju srčanih valvula. Cilj rada bio je prikaz preliminarnih rezultata pristupa kroz gornju parcijalnu mini-sternotomiju u hirurgiji mitralnih i aortnih valvula. Metode. Ova prospektivna studija obuhvatila je sve bolesnike operisane pristupom kroz parcijalnu gornju sternotomiju u periodu novembar 2008 -avgust 2009. Analizirani su podaci o prosečnoj starosti bolesnika, prosečnom vremenu do ekstubiranja, prosečnom gubitku krvi na dren, prosečnoj dužini hospitalizacije i učestalosti postoperativnih komplikacija (krvarenje, infekcija operativnog mesta, cerebrovaskularni inzult). Rezultati. U posmatranom periodu u Klinici za kardiovaskularnu hirurgiju Instituta za kardiovaskularne bolesti Vojvodine u Sremskoj Kamenici izvedeno je 17 mini-sternotomija, pri čemu je izvršena zamena aortne valvule kod 14 bolesnika (82,35%), a mitralne valvule kod 3 bolesnika (17,65%). Prosečna starost bolesnika iznosila je 60,78 ± 12,99 godina (bilo je 64,71% muškaraca i 35,29% žena). Prosečno vreme do ekstubacije iznosilo je 12,53 ± 8,87 časova sa 23,5% bolesnika ekstubiranih za manje od 8 časova. Prosečna dužina hospitalizacije iznosila je 12,35 ± 10,17 dana (kod 29,4% bolesnika manje od 8 dana). Prosečan gubitak krvi na dren iznosio je 547,06 ± 335,2 mL. Postoperativne komplikacije bile su krvarenje (5,88%) i cerebrovaskularni inzult (5,88%). Konverzija u punu sternotomiju učinjena je kod jednog bolesnika (5,88%). Zaključak. Parcijalna gornja središnja sternotomija omogućuje optimalan hirurški pristup za intervencije na čitavoj ascendentnoj aorti (uključujući aortni zalistak) i mitralnom zalisku kroz krov leve pretkomore i ima nekoliko značajnih prednosti u odnosu na klasičan pristup totalnom sternotomijom. Ključne reči: zalisci srca, bolesti; zalistak, aortni; zalistak, mitralni; lečenje; hirurgija, minimalno invazivne procedure; lečenje, ishod. Abstract Background/Aim. The last decade of the 20 th century brought up a significant development in the field of minimally invasive approaches to the valvular heart surgery. Potential benefits of this method are: good esthetic appearance, reduced pain, reduction of postoperative hemorrhage and incidence of surgical site infection, shorter postoperative intensive care units (ICU) period and overall in-hospital period. Partial upper median sternotomy currently presents as a state-of-the art method for minimally invasive surgery of cardiac valves. The aim of this study was to report on initial experience in application of this surgical method in the surgery of mitral and aortic valves. Methods. The study was designed and conducted in a prospective manner and included all the patients who underwent minimally invasive cardiac valve surgery through the partial upper median sternotomy during the period November 2008 -August 2009. We analyzed the data on mean age of patients, mean extubation time, mean postoperative drainage, mean duration of hospital stay, as well as on occurance of postoperative complications (postoperative bleeding, surgical site infection and cerebrovascular insult). Results. During the observed period, in the Institute for Cardiovascular Diseases of Vojvodina, Clinic for Cardiovascular Surgery, 17 ministernotomies were performed, with 14 aortic valve replacements (82.35%) and 3 mitral valve replacements (17.65%). Mean age of the patients was 60.78 ± 12.99 years (64.71% males, 35.29% females). Mean extubation time was 12.53 ± 8.87 hours with 23.5% of the patients extubated in less than 8 hours. Mean duration of hospital stay was 12.35 ± 10.17 days (in 29.4% of the patients less than 8 days). Mean postoperative drainage was 547.06 ± 335.2 mL. Postoperative complications included: bleeding (5.88%) and cerebrovascular insult (5.88%). One patient (5.88%) required conversion to full sternotomy. Conclusion. Partial upper median sternotomy represents the optimal surgical method for the interventions on the whole ascendant aorta (including aortic valve) and mitral valve through the roof of the left atrium, with a few significant advantages compared to the full sternotomy surgical approach.
doi:10.2298/vsp1105405k pmid:21744651 fatcat:tm3k7oiz25e2bnmy7ll6aya7em